How it is administered

Ifosfamide is given as an intravenous (IV) infusion, meaning it is administered directly into a vein. It comes in single-dose vials containing either 1 gram or 3 grams of sterile ifosfamide powder, which is dissolved in a liquid before use. The typical dose is 1.2 grams per square meter of body surface area per day, given over at least 30 minutes, for 5 consecutive days. This cycle is usually repeated every 3 weeks or after blood counts recover. Extensive hydration (at least 2 liters of fluid per day) and a protective medication called mesna are used alongside ifosfamide to help prevent bladder toxicity.

How it works

Ifosfamide is a type of chemotherapy known as an alkylating agent. It is considered a prodrug, which means it needs to be activated by the liver before it can work. Once activated, ifosfamide forms compounds that attach to the DNA inside cancer cells. This process, called alkylation, causes cross-links in the DNA, which prevents the cancer cells from dividing and growing. Ultimately, this leads to the death of the cancer cells.

Because ifosfamide targets rapidly dividing cells, it can also affect healthy cells that grow quickly, such as those in the bone marrow, hair follicles, and digestive tract. This is why side effects can occur. The medication is processed by the liver and most of it is eliminated from the body in the urine.

Who Should take it

Ifosfamide is used in adults as part of combination chemotherapy regimens for certain types of cancers. According to its FDA label, it is specifically indicated for use in combination with other approved chemotherapy drugs as third-line treatment for germ cell testicular cancer. While not specifically approved for anaplastic large cell lymphoma (ALCL), ifosfamide is sometimes used off-label in combination regimens for various blood cancers, including lymphomas, when other treatments have not been effective.

Your doctor will determine if ifosfamide is appropriate for you based on your type of cancer, previous treatments, and overall health. It is important to discuss the potential benefits and risks with your healthcare team.

Who should not take it

Ifosfamide should not be used in patients who have a known hypersensitivity (allergic reaction) to ifosfamide. It is also contraindicated in patients with urinary outflow obstruction (blockage that prevents urine from leaving the bladder), as this can increase the risk of bladder toxicity.

Additionally, ifosfamide should be used with great caution, if at all, in patients with severely depressed bone marrow function, active infections, or severe immunosuppression. It is not recommended for use during pregnancy or breastfeeding, as it can cause harm to the fetus or infant. Patients with significant kidney or liver impairment may also need special consideration or dose adjustments.

Commonly used with

Ifosfamide is almost always used in combination with other chemotherapy agents. For testicular cancer, it is commonly combined with cisplatin and either etoposide or vinblastine. When used for blood cancers such as lymphoma, it may be combined with drugs like doxorubicin, vincristine, and prednisone, among others. Mesna is routinely given alongside ifosfamide to protect the bladder from harmful effects.

Commonly tested with

Ifosfamide has been tested in clinical trials in combination with other chemotherapy drugs such as cisplatin, etoposide, and vinblastine. These combinations are used to improve effectiveness and target cancer cells in different ways. In blood cancers, ifosfamide is often studied as part of multi-drug regimens to determine the best treatment strategies for patients who have not responded to standard therapies.