Tsavaris, N., Kosmas, C., Vadiaka, M., Zonios, D., Papalambros, E., Papantoniou, N., … Koufos, C. (2003). Amifostine, in a reduced dose, protects against severe diarrhea associated with weekly fluorouracil and folinic acid chemotherapy in advanced colorectal cancer: A pilot study. Journal of Pain and Symptom Management, 26(3), 849–854.doi: 10.1016/S0885-3924(03)00283-5
Patients with colorectal cancer who experienced persistent diarrhea with fluorouracil (5-FU) and calcium folinate infusion despite dose reductions were treated with 800 mg/m2, 500 mg/m2, or 150 mg/m2 amifostine. Amifostine works by selectively protecting normal but not tumor tissues from cytotoxic effects of radiation therapy and chemotherapy.
Although previous studies have found that doses of amifostine between 740–910 mg/m2 are effective, this study suggested that lower doses may be effective and increase tolerability. The study suggested that 20% of the usual dose of amifostine is capable of offering adequate protection against diarrhea and mucositis associated with 5-FU. Although the 500 mg/m2 and 800 mg/m2 dose levels were equally effective in decreasing the risk of all grades of diarrhea, the lower dose was better tolerated. The 150 dose level was the best tolerated and was nearly as effective as higher doses in preventing severe and grade 1 diarrhea. Amifostine appears to offer protection against gastrointestinal adverse effects and permit higher doses of 5-FU.