Effect of Amifostine on Survival Among Patients Treated With Radiotherapy: A Meta-Analysis of Individual Patient Data

Purpose Controversy exists regarding whether or not amifostine might reduce the efficacy of cancer treatment. The aim of this meta-analysis was to evaluate the impact of amifostine on overall survival (OS) and progression-free survival (PFS) in patients treated with radiotherapy or chemoradiotherapy. Material and Methods Updated data from individual patients with non-small-cell lung cancer, head and neck squamous cell carcinoma, and pelvic cancer treated with radiotherapy or chemoradiotherapy and randomly assigned to amifostine or not were included. The primary end point was OS. Results Twenty-two randomized trials (2,279 patients) were potentially eligible. Data were available for 16 trials (1,554 patients), but four trials (435 patients) were excluded after data checking. Ultimately 12 trials and 1,119 patients were analyzed. A total of 431 patients were treated with radiotherapy alone (three trials), and 688 patients were treated with chemoradiotherapy (nine trials). Thirty-three percent of patients had lung cancers, 65% had head and neck cancers, and 2% had pelvic carcinomas. Ninety-one percent of patients had locally advanced disease (early stage, 9%). Median follow-up was 5.2 years. The hazard ratio (HR) of death was 0.98 (95% CI, 0.84 to 1.14; P = .78). On the basis of 11 trials (1,091 patients), the HR of progression, relapse, or death was 1.05 (95% CI, 0.90 to 1.22; P = .53). The tests for heterogeneity were not significant (P >= .73), and there was no significant variation of treatment effect according to sex, age, tumor site, stage, histology, locoregional treatment, or type of administration for either end point. Conclusion Amifostine did not reduce OS and PFS in patients treated with radiotherapy or chemoradiotherapy. J Clin Oncol 29:2590-2597. (C) 2011 by American Society of Clinical Oncology