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Normal Tissue Tolerance
Published in Loredana G. Marcu, Iuliana Toma-Dasu, Alexandru Dasu, Claes Mercke, Radiotherapy and Clinical Radiobiology of Head and Neck Cancer, 2018
Loredana G. Marcu, Iuliana Toma-Dasu, Alexandru Dasu, Claes Mercke
Palifermin was also proven effective in reducing severe mucositis in HNC patients treated with cisplatin-based chemoradiotherapy (Le et al. 2011). In a randomised placebo-controlled trial enrolling 188 patients, half of HNC patients treated with conventionally fractionated chemoradiotherapy also received palifermin (180 μg/kg) before starting treatment and then once a week for 7 weeks. The incidence of oral mucositis was notably lower in this arm as compared to placebo (54% vs 69%, p = 0.041), and the median duration of severe mucositis was also significantly reduced in the palifermin arm (5 vs 26 days). Overall survival and progression-free survival were not influenced by the radiation mitigator and they were similar between the two arms (Le et al. 2011). Weekly palifermin of 120 μg/kg was administered during the course of chemoradiotherapy in a European randomised placebo-controlled trial that enrolled a similar number of patients (186) as the above American study and reported very similar results, thus confirming the potential role of palifermin in the prevention of radiation-induced mucositis (Henke et al. 2011). Past trials evaluating smaller doses of palifermin (60 μg/kg per week) with concurrent chemoradiotherapy in HNC patients did not show any protective effect (Brizel et al. 2008). Although higher doses, as reported by the above randomised trials have proven effective, caution should be taken when designing further trials as the toxicity profile of palifermin and its long-term effects are not fully documented.
General Management of Blood Cancers
Published in Tariq I Mughal, John M Goldman, Sabena T Mughal, Understanding Leukemias, Lymphomas, and Myelomas, 2017
Tariq I Mughal, John M Goldman, Sabena T Mughal
Many of the drugs used for the treatment of blood cancers have a potential to result in mucositis, which can enhance the incidence of bacterial infections. To this effect, specialists use Clorhexidine (or similar) mouthwashes and even oral nonabsorbed antibiotics to reduce gut commensal flora. Some advocate the use of a novel treatment with a keratinocyte growth factor called Palifermin, which reduces the severity of oral mucositis and the use of a “neutropenic” diet when a patient has prolonged periods of neutropenia (Fig. 7.6). We discuss both of these latter aspects in chapter 12.
Development of palliative medicine in the United Kingdom and Ireland
Published in Eduardo Bruera, Irene Higginson, Charles F von Gunten, Tatsuya Morita, Textbook of Palliative Medicine and Supportive Care, 2015
In the last 5 years, palifermin, a recombinant humanized keratinocyte growth factor (rHuKGF), has demonstrated an ability to decrease the incidence and duration of mucositis in randomized, placebo-controlled studies and in systematic reviews. The drug seems to be generally well tolerated, but most patients experienced thickening of oral mucosa, flushing, and dysgeusia 36***,37**.
Chemotherapy-Induced Oral Complications and Prophylaxis Strategies
Published in Cancer Investigation, 2023
Aleksandra Śledzińska, Paulina Śledzińska, Marek Bebyn, Oskar Komisarek
Clinical practice guidelines from MASCC/ISOO, ESMO, the American Society of Clinical Oncology (ASCO), and the National Comprehensive Cancer Network (NCCN) recommend using prophylactic palifermin in patients with hematologic malignancies undergoing autologous HCT utilizing regimens that incorporate total-body irradiation (15,40,58,59). It was proven in five randomized trials performed by the MASCC/ISOO (60) and a double-blind, placebo-controlled multicenter trial (61,62). In 2004, the U.S. Food and Drug Administration authorized palifermin to alleviate the symptoms of severe oral mucositis in patients with hematological malignancies receiving myeloablative therapy, followed by hematopoietic stem cell support (63). However, as chemotherapy-only regimens followed by autologous HCT have mainly replaced radiation-based conditioning regimens, the use of palifermin has decreased significantly.
Radio-Protective effect of aminocaproic acid in human spermatozoa
Published in International Journal of Radiation Biology, 2022
Timur Saliev, Ildar Fakhradiyev, Shynar Tanabayeva, Yelena Assanova, Dinmukhamed Toishybek, Aigul Kazybayeva, Baimakhan Tanabayev, Marat Sikhymbaev, Aliya Alimbayeva, Yerzhan Toishibekov
The protection of human tissues and organs from the damaging effects caused by ionizing radiation remains a significant challenge for healthcare organizations around the world. Despite the numerous attempts to find a remedy against radiation-induced effects, there is no effective and proven drug that can guarantee the full radio-protection. Up to date, only two drugs (amifostine and palifermin) received FDA approval as a radio-protective agent. The amifostine has been recommended for the reduction of the risk of xerostomia (mouth dryness) for patients who undergo radiotherapy (Koukourakis et al. 2018; Singh and Seed 2019; Boutros et al. 2021). Palifermin was developed to decrease the risk of the oral mucositis for patients treated with radiation (McDonnell and Lenz 2007; Bossi et al. 2012).
Palifermin as primary mucositis prophylaxis in patients with B-cell Non-Hodgkin lymphoma: a case series
Published in Pediatric Hematology and Oncology, 2022
Anthony S. Zembillas, Stefanie M. Thomas, Seth J. Rotz, Ilia N. Buhtoiarov, Rabi Hanna
Palifermin, a human recombinant keratinocyte growth factor, is approved by the Food and Drug Administration to decrease the incidence of oral mucositis associated with hematopoietic stem cell transplantation (HSCT). It has also shown positive effects on reducing mucositis frequency and severity in children receiving cancer therapy.4,5 Liu et al2 evaluated the use of palifermin as secondary mucositis prophylaxis in non-HSCT pediatric patients, including those with NHL. Patients had less reoccurrence of mucositis, decreased opioid and antibiotic use, and decreased duration of hospitalization. Single dose palifermin was also utilized as the pharmacokinetic profile is comparable to standard dose for adult patients.6,7 Here we describe our experience with single dose palifermin as primary mucositis prophylaxis in two patients receiving therapy per Group B and Group C1 (CSF negative) of ANHL1131. Patients in both groups receive initial therapy with cyclophosphamide, vincristine, and prednisone (COP) followed by 4–6 cycles of additional chemotherapy as well as intrathecal chemotherapy. After completion of COP patients in Group B receive two cycles of rituximab, cyclophosphamide, vincristine, prednisone, doxorubicin, and high dose methotrexate (R-COPADM) followed by two cycles of rituximab, cytarabine, and high dose methotrexate (R-CYM). After completion of COP patients in Group C1 (CSF negative) receive two cycles of R-COPADM followed by two cycles of rituximab, cytarabine, high dose cytarabine, and etoposide (R-CYVE). After completion of R-CYVE patients receive one cycle of COPADM followed by one cycle of cytarabine and etoposide.