Amifostine

Amifostine was approved in December 1995 to reduce cumulative renal toxicity from repeated cisplatin in advanced ovarian cancer and in 1999 to reduce moderate to severe xerostomia during post-operative radiotherapy for head and neck cancer when the field includes much of the parotid glands, on randomised trials in each setting. Concern that a radioprotector might also shield tumours, together with nausea, hypotension during infusion and skin reactions, has confined it to selected patients, and intensity-modulated radiotherapy has largely replaced it for salivary sparing. Guidelines (ASCO, MASCC) list it as an option rather than a standard.