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According to a recent article published in the journal Cancer, the cytoprotective agent Ethyol® (amifostine) may allow for greater delivery of chemotherapy in the treatment of head and neck cancer. Future trials are necessary to determine if this will result in improved survival for these patients.

Approximately 40,000 people in the US are diagnosed with head and neck cancer every year. Cancers of the head and neck include cancers of the nasal cavity and sinuses, mouth, and throat. According to the American Cancer Society, 11,000 people died from head and neck cancer in 2004.

Standard treatment for head and neck cancer is largely determined by the stage (extent to which the cancer has spread) and by the specific locations within the head or neck area where the cancer has spread. Radiation therapy and chemotherapy tend to be commonly used.

Unfortunately, side effects caused by radiation therapy (ulcers, dry mouth, burning of the tissue at the site the radiation is aimed) are common. In addition to drastically reducing the quality of life of patients, these side effects often cause administration of chemotherapy or additional radiation therapy to be delayed or cancelled. Postponing of missing just one dose of therapy may result in compromised outcomes, including a worsening of overall survival. Therefore, preventing these side effects from occurring altogether or reducing their severity is crucial in providing optimal outcomes.

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Over the past 50 years, many drugs called radiation protectors have been tested in the laboratory for prevention of radiation damage to normal cells and tissues. For such drugs to effectively treat cancer, they must protect only normal cells-not the cancer cells-from radiation. Ethyol is a radiation protector and the only drug that has been approved by the US Food and Drug Administration (FDA) for use in patients receiving radiation therapy for cancers of the head and neck.

A multi-institution clinical trial was recently conducted to evaluate Ethyol in the treatment of head and neck cancer. This trial included 36 patients with advanced head and neck cancer. Patients were treated with radiation therapy plus the chemotherapy agent Taxol® (paclitaxel). Twenty-eight of these patients received Ethyol; eight received no amifostine.

Patients treated with amifostine could tolerate an additional cycle of Taxol compared to those not treated with amifostine. At approximately 30 months, both progression-free and overall survival was 66% in the whole group of patients (researchers had not separated results from those who were treated with amifostine versus those who were not).

The researchers concluded that amifostine allows patients with advanced head and neck cancer who are also undergoing radiation therapy to tolerate extra cycle of chemotherapy. Longer follow-up is necessary to determine if this will result in improved survival for these patients, and future clinical trials are necessary to provide confirmed results. Patients with head and neck cancer who are to undergo radiation therapy may wish to speak with their physician regarding their individual risks and benefits of treatment with Ethyol.

Reference: Amrein P, Clark J, Supko J, et al. Phase I trial and pharmacokinetics of escalating doses of paclitaxel and concurrent hyperfractionated radiotherapy with or without amifostine in patients with advanced head and neck carcinoma. Cancer. 2005;104:1418-1427.