[Anticancer chemotherapy. Prevention of toxicity].

A MAJOR CHALLENGE: Prevention of short and long term toxicity of chemotherapy is an important challenge in oncology in order to maintain the dose/intensity of protocols and to increase patient comfort. AVAILABLE CHEMOPROTECTORS: Amifostine protects against the blood, kidney and nerve toxicity of cisplatin. Protection is less evident for carboplatin and should be further evaluated for alkylating agents, anthracyclines and taxans. Dexrazoxane protects against the cumulative cardiotoxicity of anthracyclines without reduction of antitumor efficacy. It must be used beyond a cumulative dose of 300 mg/m2 doxorubicin (or equivalent) in responsive patients. Its use in the curative treatment of lymphoma should be assessed by further clinical trials. Mesna must be widely used to prevent the urotoxicity of cyclophosphamide and ifosfamide. An oral preparation is now available for outpatients. Protection of the gonadic function could be achieved by LH-FH analogs in young women. PERSPECTIVES: Due to their high cost and the risk of diminishing the antitumor efficacy in curable diseases, a precise evaluation of present and future chemoprotectors is necessary before wider use.