Be very cautious and careful with the amifostine -- follow *all* the Medimmune recommendations to the letter. They ave a brochure for patients, ask for it. The reason (at Hopkins, per our RO) most patients cannot tolerate more than 3-4 weeks of injections (if that) is that they develop persistent lingering nausea, which is exacerbated by the chemotherapy (especially if they get cisplatin). The good thing is that even a partial treatment seems to help.

My husband got through the whole series of shots but was meticulous about following the guidelines, and also, he did not take Ethyol on his 7 chemotherapy days. He was given carboplatin, which (although a strong emetic) seems not to cause such lingering days-long nausea as does cisplatin, so that undoubtedly helped.

To reiterate:

1) Drink 20-24 oz. of water (jello also counts) starting 90 minutes before the injections. The hydration helps prevent blood pressure drop (see below) and nausea.
2) Take a *serious* anti-nausea med 90 minutes beforehand. My husband took Zofran or Anzemet, the latter towards the end when the Zofran didn't work as well, these are *expensive* drugs but worth every penny if they get you through the Ethyol. Compazine did NOT work!
3) Apply hydrocortisone cream immediately to injection sites (rash, which can become generalized, is another side effect).
4) Your nurse will take blood pressure before administering the injections, and the med will probably not be given if BP below 100. BP will be taken again 15 minutes afterwards. Serious BP drops were common when Ethyol was given IV, not so common now it's given sub-cutaneously, but not unknown.
5) Close coordination with radiation team, radition must be given in a 30-45 minutes "window" after the injections.

On the plus side, it does work to protect salivary glands and there have been some recent papers showing a reduced severity of mucositis (which our dental onc firmly believes). Barry never had really bad mucositis, he ate all the way through and has salivary function in both parotids, even the one which got almost the full radiation dose, which his RO thought would be "wiped out,"

Gail