Anticancer chemotherapy: prevention of toxicity

A major challenge: Prevention of short and long term toxicity of chemothera py is an important challenge in oncology in older to maintain the dose/inte nsity oi protocols and to increase patient comfort. Available chemoprotectors: Amifostine protects against the blood, kidney an d nerve toxicity of cisplatin. Protection is less evident for carboplatin a nd should be further evaluated for alkylating agents, anthracyclines and ta xans. Dexrazoxane protects against the cumulative cardiotoxicity of anthrac yclines without reduction of antitumor efficacy. It must be used beyond a c umulative dose of 300 mg/m(2) doxorubicin (or equivalent) in responsive pat ients. its use in the curative treatment of lymphoma should be assessed by further clinical trials. Mesna must be widely used to prevent the urotoxici ty of cyclophosphamide and ifosfamide. An oral preparation is now available for outpatients. Protection of the gonadic function could be achieved by L H-FH analogs in young women. Perspectives: Due to their high cost and the risk of diminishing the antitu mor efficacy in curable diseases, a precise evaluation of present and futur e chemoprotectors is necessary before wider use.