Amifostine is a cytoprotective adjuvant used in cancer chemotherapy
involving DNA-binding chemotherapeutic agents. It is marketed by MedImmune
under the trade name Ethyol.

Amifostine is used therapeutically to reduce the incidence of neutropenia-related
fever and infection induced by DNA-binding chemotherapeutic agents including
alkylating agents (e.g. cyclophosphamide) and platinum-containing agents
(e.g. cisplatin). It is also used to decrease the cumulative nephrotoxicity
associated with platinum-containing agents. Amifostine is also indicated
to reduce the incidence of xerostomia in patients undergoing radiotherapy
for head and neck cancer.

Of note, amifostine was originally indicated to reduce the cumulative
renal toxicity from cisplatin in non-small cell lung cancer. However,
while nephroprotection was observed, the fact that amifostine could
protect tumors could not be excluded. Given better treatment options for
non-small cell lung cancer, this indication for non-small cell lung cancer
was withdrawn in 2005.

Amifostine is an organic thiophosphate prodrug which is dephosphorylated
in vivo by alkaline phosphatase to the active cytoprotective thiol metabolite.
The selective protection of non-malignant tissues is believed to be due
to higher alkaline phosphatase activity, higher pH, and vascular permeation
of normal tissues.