Amifostine reduces side effects and improves complete response rate during radiotherapy: Results of a meta-analysis

Purpose: To evaluate the efficacy of amifostine in diminishing radiotherapy side effects and whether or not it protects the tumor. Methods and Materials: We performed a systematic review and meta-analysis of 14 included randomized controlled trials, comprising 1451 patients, comparing the use of radiotherapy vs. radiotherapy plus amifostine for cancer treatment. Results: The use of amifostine significantly reduced the risk of developing mucositis (odds ratio [OR], 0.37; 95% confidence interval [CI], 0.29–0.48; p < 0.00001), esophagitis (OR, 0.38; CI, 0.26–0.54; p < 0.00001), acute xerostomia (OR, 0.24; CI, 0.15–0.36; p < 0.00001), late xerostomia (OR, 0.33; CI, 0.21–0.51; p < 0.00001), dysphagia (OR, 0.26; CI, 0.07–0.92; p = 0.04), acute pneumonitis (OR, 0.15; CI, 0.07–0.31; p < 0.00001) and cystitis (OR, 0.17; CI, 0.09–0.32; p < 0.00001). There was no difference in overall response rate between the groups. However, complete response rate was superior for patients using amifostine (OR, 1.81; CI, 1.10–2.96; p = 0.02). Conclusions: This systematic review shows that amifostine significantly reduces the side effects of radiation therapy. The efficacy of radiotherapy was not itself affected by the use of this drug and patients receiving amifostine were able to achieve higher rates of complete response.