Common brand names

• Ifex

How it is administered

Ifosfamide is given as an intravenous (IV) infusion, meaning it is administered directly into a vein. The medication comes in single-dose vials that are reconstituted with sterile water and then further diluted for infusion. 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. Treatment cycles are usually repeated every 3 weeks or after recovery from blood count suppression. Extensive hydration (at least 2 liters of fluid per day) and the use of mesna are important to reduce bladder toxicity.

How it works

Ifosfamide is a type of chemotherapy known as an alkylating agent. It is a prodrug, which means it needs to be activated by the liver before it can work. Once activated, ifosfamide forms substances that attach to the DNA inside cancer cells. This process, called alkylation, creates cross-links in the DNA, which prevents the cancer cells from dividing and growing. As a result, the cancer cells die. Ifosfamide is particularly effective against rapidly dividing cells, which is why it is used to treat certain types of cancers, including blood cancers and testicular cancer.

Because ifosfamide affects all rapidly dividing cells, it can also impact healthy cells, especially those in the bone marrow, digestive tract, and hair follicles, leading to side effects such as low blood counts, nausea, and hair loss. The medication is processed and eliminated by the kidneys, so kidney function is monitored closely during treatment.

Who should take it

Ifosfamide is used in adults, in combination with other chemotherapy drugs, as a third-line treatment for germ cell testicular cancer. While its main FDA-approved use is for testicular cancer, ifosfamide is also sometimes used off-label for other cancers, including certain blood cancers, sarcomas, and lymphomas, especially when other treatments have not been effective.

Your doctor may recommend ifosfamide if you have a type of cancer that has not responded to other treatments, or if you have relapsed after previous therapies. The decision to use ifosfamide is based on your overall health, kidney function, previous treatments, and the type of cancer you have.

Who should not take it

Ifosfamide should not be used in patients who have had a known allergic reaction to ifosfamide or any of its components. It is also contraindicated in patients with urinary outflow obstruction, as the medication and its byproducts are eliminated through the urine and can cause bladder toxicity.

If you have severely depressed bone marrow function, active infections, or very low blood counts, your doctor may delay or avoid ifosfamide treatment. Pregnant women should not use ifosfamide, as it can cause harm to the unborn baby. Women should avoid becoming pregnant and men should not father a child during and for several months after treatment. If you have significant kidney or liver impairment, your doctor will consider these risks before prescribing ifosfamide.

Commonly used with

Ifosfamide is most commonly used in combination with other chemotherapy drugs. For testicular cancer and some blood cancers, it is often combined with cisplatin and either etoposide or vinblastine (the VIP regimen). Mesna is always used alongside ifosfamide to protect the bladder from damage.

Your doctor may also prescribe medications to prevent nausea, manage infections, and support your blood counts during treatment.

Commonly tested with

Ifosfamide has been tested in clinical studies in combination with cisplatin and either etoposide or vinblastine, especially for testicular cancer. These combinations are also used in some blood cancers and sarcomas. The effectiveness and safety of ifosfamide are often compared to other chemotherapy regimens in clinical trials, and it is studied with supportive medications like mesna to reduce side effects.