Nicolatou-Galitis, O., Sarri, T., Bowen, J., Di Palma, M., Kouloulias, V.E., Niscola, P., . . . Mucositis Study Group of the Multinational Association of Supportive Care in Cancer/International Society of Oral Oncology (MASCC/ISOO). (2013). Systematic review of amifostine for the management of oral mucositis in cancer patients. Supportive Care in Cancer, 21(1), 357–364. 

DOI Link

Purpose

STUDY PURPOSE: To review available literature from 1966 to December 31, 2010 to define clinical practice guidelines for the use of amifostine for prevention and treatment of oral mucositis in patients with cancer

TYPE OF STUDY: Systematic review

Search Strategy

DATABASES USED: MEDLINE

KEYWORDS: Extensive list provided (anti-inflammatory agents) including amifostine, antitumor necrosis factor (TNF), non-steroidal anti-inflammatory drugs, TNF inhibitor, etc.

INCLUSION CRITERIA: Detailed information is provided in a different section of the journal. Studies relevant to the management of radiation and/or chemotherapy-induced oral mucositis using anti-inflammatory interventions including amifostine

EXCLUSION CRITERIA: Articles that did not report on intervention and mucositis outcomes, animal or in vitro studies, non-English articles, methodologic quality, and anti-inflammatory agents other than amifostine

Literature Evaluated

TOTAL REFERENCES RETRIEVED: 908

EVALUATION METHOD AND COMMENTS ON LITERATURE USED: Only articles that investigated amifostine specifically were selected. Levels of evidence were based on the Somerfield criteria, and study methodology was evaluated on the Hadorn criteria. These were integrated into guideline categories—recommendation, suggestion, or no guideline possible.

Sample Characteristics

  • FINAL NUMBER STUDIES INCLUDED = 30
  • SAMPLE RANGE ACROSS STUDIES, TOTAL PATIENTS INCLUDED IN REVIEW: Not indicated
  • KEY SAMPLE CHARACTERISTICS: Head and neck, high-dose chemotherapy, chemotherapy and radiation

Phase of Care and Clinical Applications

PHASE OF CARE: Active antitumor treatment

Results

No guideline, suggestion, or recommendation for mucositis prevention with amifostine was possible in any of the following groupings.

  • Head and neck radiotherapy
  • Head and neck chemotherapy/radiation
  • High-dose chemotherapy
  • Standard-dose chemotherapy
  • Radiotherapy alone
  • Chemotherapy/radiation prevention

Conclusions

Conflicting results, insufficient data, and major Hadorn flaws did not allow any guideline related to the use of amifostine for oral mucositis prevention. New well-designed trials are necessary that include timing of amifostine infusion prior to radiotherapy, consistent dose of amifostine, and cancer therapy intensity and modality.

Limitations

Too many studies may have been eliminated up front.

Nursing Implications

Because no guidelines are recommended by this review, nurses who continue to administer amifostine for mucositis prevention carefully should document the results and look for ways to participate in well-designed trials. Nurses may consider advocating against the use of amifostine outside of research until guidelines can be established for its use.

Legacy ID

4063