I have a recently diagnosed 1cm lateral base tongue HPV instigated tumor and one node that

Michael,

I haven't heard of amifostine.

I did a little research and came up with the following site.
http://www.bccancer.bc.ca/HPI/DrugDatabase/DrugIndexPro/amifostine.htm

My interpretation based on this information and my medline search is that it is a promising drug. I do however, have concerns. Most of the information that I have read keeps leading back to its "antitumorgenic" side effects. I understand this to mean that it decreases the effectiveness of chemo and RT in reducing/eliminating tumor growth. I am in no way an expert or acquainted with this medication.
May I suggest discussing its potential benefit to you with your Oncologist.

Hope this is of some use.

Cheers,

Mike

Amifostine is a very difficult treatment for many here. It is given to prevent loss of salivary function. If you are getting IMRT you may not need it.

MedImmune produced this drug several years ago in an effort to protect the salivary glands from radiation. Many posters here have used it with varying success. While not speaking for them, my impression from the hospitals that I talk with and the posters here is this. It may indeed offer some radioprotection, but it does not work for everyone, and it does not offer 100% effectiveness even in the best cases. It has a brutal nausea component to its use, which can be offset to some extent by anti-nausea meds prior to use. Were it available to me, I would take a shot at it and see if I could tolerate the side effects and hope for the protection it may provide.

Many docs do not tell their patients about it because they have had such difficulty with past ones tolerating its use. But I think doctors recommendation or not, it's worth an attempt. You can always discontinue its use if it knocks you for a loop with no further ill effects. And if you find you can tolerate it, you may have a bit more saliva when the dance is over, and that will certainly improve your quality of life, and the health of your mouth long term.

Respectfully to Dr. Mike, stated by someone who is only a lay person - MedImmune has tried to play on some other collateral benefits of the drug ancillary to its original intended use, to boost use and sales (effects not well documented or significantly supported by evidence of consequence). In that case antitumerogenic mean the opposite of what you have stated; that it aids other treatments, not that it interferes with them.

Brian,

Sounds like you summed it all up. Everybody is different. If you can add it to your cocktail and tolerate it and it works great.

It wouldn't still be on the shelf if it hasn't benefitted some patients.

Mike

Doesn't anyone prescribe Salagen anymore or is it Amifostine or nothing? The only side effect I had from Salagen was heavy sweating for about 15 minutes about a half hour after I took it. I can only assume it worked because I have a fair amount of saliva and no need for the water bottle. Just an alternative with little side effects unless you live in a very humid climate.

Take care,
Eileen

Eileen,
Salagen is one of the trade names that pilocarpine is sold under. The drug is the same, it's like Motrin and Advil thay are both brand names for the drug Iboprofen.

Hope all is well,

Cheers,

Mike

I had amifostine during treatment and salagen prescribed after treatment was over. I still take salagen and it does help a litle in giving me more saliva.

Hi Micheal, Jack was able to successfully complete the entire course of amifostine. He thinks it helped with the saliva and preventing fibrosis. If you'e going to do it make sure you follow the recommended protocols for drinking 2-3 quarts of water, and using heavy duty anti-nausea drugs (Jack used zofran twice a day every day as a precaution, and compazine for breakthru nausea).

I can't stress the need for hydration strongly enough. It helps with all the side effects. He had to drink 16-24 oz of water 90 minutes before the shot. Jack thought getting the shot itself was painful but he'd also do it again. Everyone's experience is different and you're the only one that can decide whether the potential benefit is worth the potential side effects. This is only 1 of many times you'll be faced with that. As Brian points out you can always stop the treatment if you're having any issues with it.

Regards JoAnne

Hi,

Sorry Brian, guess I should be more careful in my typing and read before I post. What I wanted to pass along was the drugs potential interference with the antitumorgenic effects of chemotherapy.

This is a quote taken directly from the website I referenced above.
"...Use with curative chemotherapy: Animal data suggest that amifostine may interfere with antitumorigenic effects of chemotherapy and amifostine is not recommended with curative chemotherapy outside of a clinical trial. Interference has not been seen in human studies of amifostine thus far.2,3 " Medline search gives similar more scientific info but, noone will say for sure.

I'll be more diligent in my proof reading in the future. Correct me anytime, no disrespect was ever even thought of Brian, I, like you want to only pass along timely accurate information. A lay person? My knowledge of your posts and information would make you more of an expert on Oc than anyone I am acquainted with.

Respectfully,

Mike

I am a new to this and am asking for a friend that is that will be starting chemo and radiation next week for lip and neck cancer. We are would appreciate any suggestions on reducing the side effects of having reduced salivary secretions. We were considering amifostine. Thanks

Brian and Gary have provided some great information on this drug in this thread. The drug wasn't available at our site for my husband...however, if it was, he would have tried it.

There is search functions at the top of the form. You can search by terms (like amifostine) or by a user such as GailMac. (Her husband, Barry, was able to tolerate the Amifostine throughout treatment). Plus they had some additional routines/treatments they used to minimize the discomfort throughout treatment.

I hope this helps. Utlimately, your friend needs to make the final decision with your CCC team. However, it's nice to come in armed with information and questions.

wishing good thoughts to you and your friend. Do you know if your friend will be treated on an IMRT?

Let me contribute what I can here. My treatment included daily Amifostine, given IV over 5 minutes, within 30 minutes of my radiation treatment. Thus, I had 39 Amifostine administrations.

I noticed no ill effects from the Amifostine at the beginning, but later on (about treatment 25), I would experience nausea about an hour after the administration. It was funny, because it was almost like clockwork. Walking from my radiation treatment to my car, the nausea would hit at about the same spot in my walk. Nothing severe, and it passed quickly. I did use Compazine at home however, in combination with a stool softener to mitigate against the constipation side effects.

In terms of impact on treatment, I discussed it with an oncological pharmacist attached to our local cancer center. He said that they have used and studied Amifostine extensively, and have not seen any adverse impact upon tumor responsiveness in their facility, but have seen positive influence in terms of salivary production.

I know that my dry mouth is actually worse now (60 days post treatment) than it was during treatment. Of course, I am no longer getting Amifostine, and I stopped the Salagen at the end of treatment. I am going to ask the doctor about that tomorrow.

Amifostine was initially used for kidney cancer treatment to protect the kidneys from radiation. Further studies revealed a similar efficacy for protection of salivary glands during radiation. Take away the horrible nausea some people have and add in many people develop an allergic type reaction starting with local redness around the injection site to full systemic allergic reaction. Many people make it half way through radiation with progressive allergic reactions. In my case, my temperature spiked within 30 minutes of the injection and 3-4 weeks into treatment I would get a fever of 104 with my entire body covered in red splotchy areas. From my eyes out, it was like having the flu and the fever associated with that. After being hospitalized several times, it was determined the Amifostine was the cause and the problem disappeared immediately after I stopped receiving the injections (first day without).

Did it help? Who knows, but just another weapon in the aresenal.

Ed

I was treated with Amifostine and I believe it helped. There is some additional monitoring during the treatment and I believe it did add to my nausea. I would highly recommend the treatment. In my case the nausea was barely controllable from day one and by the final week of treatment I could not wear my teeth guard during the radiation treatment because of this. It was miserable but at 1 1/2 years out -
-I still have my teeth
-My saliva glands though not perfect are still partially functional
-I am eating (mildly) spicy foods again.
Remember there are no do-overs and its not going to be easy! Thats why you get the nausea medicine and the pain-killers.

I also recommend drinking at least one cup of room temperature green tea a day. This will keep excersizing your throat muscles.

Thanks for all the feedback. My radiation oncologist thinks Amifostine is not worth the trouble but I think anything that might help quality of life is worth a shake. I'm to receive three subcutaneous injections per week prior to radiation treatment. Apparently the three injections have proven to be as effective as daily, although this make no sense to me whatsoever because it would need to be in my system to be a chemo/radio protectorant.

Michael,
are you getting XRT or IMRT? If you are getting IMRT and the salivary glands are not in the direct beam path, they will recover in about 18 months time with or without amifostine.

Your research is quite correct - the jury (i.e. NCCN) is out about adjunctive chemo for Stage I tumors. Ultimately you will have to decide what weapons you want to use. Remember that chemo, as a stand alone has not proven effective for H&N cancer so should you have a recurrence you would lose the additional benefit of the combination treatment. The risk is toxicity from the chemo agent. For many of us the radiation had the worst collateral damage.

I might also add that there is quite a bit of difference between tough fibery tongue tissue and lymph type tonsil tissue, meaning that tongue tumors are inherently more difficult to treat - another factor to consider with your RO and MO. Was your advice from a tumor board or just individual MD opinions?