Cisplatin, radiation, and amifostine in carcinoma of the uterine cervix

Abstract

A pilot, open, comparative study was performed on patients with locally advanced cervical cancer to investigate the efficacy and safety of amifostine. Twenty patients with a histologic diagnosis of squamous cervical cancer were treated with radiotherapy and randomized in two groups. Group A received cisplatin at 20 mg/m2 for five days in two cycles during intracavitary radiotherapy and 100 mg/m2 x 2 cycles during external radiotherapy, and amifostine 825 mg/m2 15 min before the cisplatin infusion. Patients in group B received cisplatin in the same doses without amifostine. All patients had complete responses during a median follow-up of 20 months. Grade three neutropenia was present in two patients in group A and in four of the control group, P = 0.31; grade 2 neurologic toxicity was seen in four patients in group B and in one of the patients in group A, P = 0.15. One patient needed temporary interruption of amifostine due to hypotension. Eight of 10 patients in group A developed hypocalcemia during the treatment with amifostine. Our findings indicate that amifostine was well tolerated. In this series a mild neurologic and hematologic protection was found in patients that received amifostine, although this was not statistically significant. No differences in disease-free survival response and overall survival was seen between the two groups.

Efficacy of Drug Interventions for Chemotherapy-Induced Chronic Peripheral Neurotoxicity: A Network Meta-analysis

“…Our result that amifostine is extremely effective in treating both overall and severe neurotoxicity is supported by the findings of various clinical trials (14, 16, 36). However, there is one exception that reports that amifostine is not able to have a preventive role in neuropathy (38).…”

Platinum-Induced Neurotoxicity and Preventive Strategies: Past, Present, and Future

“…There are successful in vitro results supporting amifostine neuroprotection against cisplatin [120], as well as against oxaliplatin [122]. Some clinical data, with different levels of reliability (Table 3), indicated that amifostine exerts some protection against peripheral neurotoxicity of carboplatin plus paclitaxel combination therapy [127][128][129]131], oxaliplatin [126], and cisplatin [133,134], whereas two other studies have failed to show significant neuroprotection against carboplatin plus paclitaxel combination therapy [130] and cisplatin [132] (Table 3). BNP7787 (Dimesna, Tavocept, 2,29-dithio-bis-ethanesulfonate) has also shown some cytoprotective activities in vitro [174].…”

Cervical cancer. The case of Mexico

“…the results of treatment. Early efforts were focused on reducing the acute and chronic radiation-associated morbidity with the use of the radioprotectant amifostine 17 as well as to the use of alfa-interferon concurrent with pelvic radiation as a radiosensitizer 18 . This latter approach, yet effective, was too toxic to be further pursued.…”