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?