How it is administered

Ifosfamide is given as an intravenous (IV) infusion, meaning it is delivered directly into a vein. The medication comes in single-dose vials that are reconstituted with sterile water and then further diluted for infusion. The usual 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 typically 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 a protective agent called mesna are required to help prevent 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 the liver before it can work. Once activated, ifosfamide forms substances that bind to the DNA inside cancer cells. This binding creates cross-links in the DNA, which prevents the cells from dividing and growing. Ultimately, this leads to cell death, especially in rapidly dividing cancer cells like those found in blood cancers.

Because ifosfamide targets dividing cells, it can also affect normal cells that grow quickly, such as those in the bone marrow, digestive tract, and hair follicles. This is why side effects like low blood counts, nausea, and hair loss are common. The drug is processed by the liver and eliminated mainly through the urine.

Who Should take it

Ifosfamide is used in adults as part of combination chemotherapy regimens for certain cancers. Its main FDA-approved use is for third-line chemotherapy of germ cell testicular cancer, but it is also used off-label for other cancers, including some types of blood cancers such as large B cell lymphoma, especially when other treatments have not worked.

Your doctor may recommend ifosfamide if your cancer has not responded to other treatments, or as part of a multi-drug regimen. It is usually given in a hospital or clinic setting, where you can be closely monitored for side effects.

Who should not take it

Ifosfamide should not be used in people who have had a severe allergic reaction to it in the past. It is also contraindicated in patients with urinary outflow obstruction (blockage in the urinary tract), as the drug and its byproducts are eliminated through the urine and can cause bladder damage.

Caution is needed in people with severely depressed bone marrow function, active infections, or significant kidney or liver impairment. Ifosfamide can cause harm to an unborn baby, so it should not be used during pregnancy unless absolutely necessary. Women should not breastfeed while receiving ifosfamide.

Commonly used with

Ifosfamide is most often used in combination with other chemotherapy drugs, such as cisplatin, etoposide, or vinblastine. In the context of blood cancers like large B cell lymphoma, it may be part of a multi-drug regimen designed to attack cancer cells in different ways.

Mesna is always given alongside ifosfamide to protect the bladder from damage. Hydration is also a key part of the regimen to help flush the drug and its byproducts from the body.

Commonly tested with

Ifosfamide has been studied in combination with drugs like cisplatin, etoposide, and vinblastine, particularly in the treatment of refractory testicular cancer. In blood cancers, it is often tested as part of salvage regimens for relapsed or refractory disease, sometimes alongside other chemotherapy agents or in clinical trials exploring new combinations.