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 suitable 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 recovery from blood cell count suppression. Extensive hydration (at least 2 liters of fluid per day) and the use of mesna are required to reduce the risk of bladder toxicity.

How it works

Ifosfamide is a type of chemotherapy drug known as an alkylating agent. It is a prodrug, which means it needs to be activated by enzymes in the liver before it can work. Once activated, ifosfamide forms substances that attach to DNA inside cancer cells. This causes crosslinks in the DNA, preventing the cells from dividing and growing. As a result, the cancer cells are damaged and eventually die.

Because ifosfamide targets rapidly dividing cells, it can also affect some normal cells in the body, such as those in the bone marrow, digestive tract, and hair follicles. This is why side effects can occur. The drug is mostly eliminated from the body through the urine, and its effects can vary from person to person due to differences in how it is metabolized.

Who Should take it

Ifosfamide is used in combination with other approved chemotherapy agents for the treatment of certain cancers. It is specifically indicated for adults as third-line chemotherapy for germ cell testicular cancer. In the context of blood cancers, ifosfamide may be included in some treatment regimens for aggressive lymphomas, such as Burkitt lymphoma, especially when other treatments have not been successful.

Ifosfamide is generally given as part of a combination chemotherapy regimen, tailored to the specific type of cancer and the patient's overall health. It should be administered by healthcare professionals experienced in cancer chemotherapy.

Who should not take it

Ifosfamide should not be used in patients who have had a known hypersensitivity (allergic reaction) to ifosfamide. It is also contraindicated in patients with urinary outflow obstruction, as the drug and its metabolites are eliminated through the urine and can cause bladder toxicity.

Caution is needed in patients with severely depressed bone marrow function, active infections, or severe immunosuppression. It should also be avoided in patients with severe kidney or liver impairment unless the benefits outweigh the risks. Ifosfamide can harm a developing fetus, so it should not be used during pregnancy unless absolutely necessary, and effective contraception is recommended during and after treatment.

Commonly used with

Ifosfamide is almost always used in combination with other chemotherapy drugs. In blood cancers like Burkitt lymphoma, it may be combined with agents such as etoposide, vincristine, doxorubicin, and cytarabine, depending on the specific treatment protocol. Mesna is always co-administered to protect the bladder from toxic effects.

Supportive medications to prevent nausea (antiemetics), antibiotics to prevent or treat infections, and growth factors to support blood cell counts may also be used alongside ifosfamide.

Commonly tested with

Ifosfamide has been studied and used in combination with several other chemotherapy agents, particularly cisplatin, etoposide, and vinblastine in regimens for testicular cancer and aggressive lymphomas. In clinical studies, these combinations were evaluated for their effectiveness and safety in patients who had not responded to previous treatments.

In blood cancers, especially in relapsed or refractory cases, ifosfamide-based regimens are often tested with other cytotoxic agents to improve outcomes.