Common brand names

• Ifex

How it is administered

Ifosfamide is given as an intravenous (IV) infusion, meaning it is administered directly into a vein. It is supplied in single-dose vials containing either 1 gram or 3 grams of sterile ifosfamide powder, which must be dissolved before use. The standard 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 mesna (a protective agent) are required to help prevent bladder toxicity. The medication is always prepared and administered by healthcare professionals in a clinical setting.

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 compounds that attach to the DNA in cancer cells. This attachment creates cross-links within the DNA, preventing the cancer cells from dividing and growing. As a result, the cancer cells 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 like low blood counts, nausea, and hair loss can occur. The drug's action is not specific to lymphoblastic lymphoma, but it is sometimes used as part of combination chemotherapy regimens for blood cancers, including lymphoblastic lymphoma, especially in cases where other treatments have not been successful.

Who should take it

Ifosfamide is approved for use in adults as part of combination chemotherapy for third-line treatment of germ cell testicular cancer. However, it is also used off-label in combination with other chemotherapy drugs to treat various blood cancers, including lymphoblastic lymphoma, especially when other treatments have not worked or when the disease has relapsed.

Your doctor may recommend ifosfamide if you have a blood cancer that is not responding to standard treatments, or if you are participating in a clinical trial. It is important to have regular blood tests and monitoring while on ifosfamide, as it can cause significant side effects. The decision to use ifosfamide will depend on your overall health, the type and stage of your cancer, and how you have responded to previous treatments.

Who should not take it

Ifosfamide should not be used in patients who have had a previous severe allergic reaction (hypersensitivity) to ifosfamide. It is also contraindicated in people with urinary outflow obstruction, as the drug can cause bladder toxicity and requires good urine flow to minimize this risk.

If you have severely depressed bone marrow function, active infections, or are pregnant, ifosfamide may not be suitable for you. Women should not become pregnant and men should not father a child during treatment and for several months after, as ifosfamide can harm the developing fetus. Patients with severe kidney or liver problems, or those with active urinary tract infections, may need to avoid ifosfamide or use it with extreme caution.

Commonly used with

Ifosfamide is almost always used in combination with other chemotherapy drugs. For blood cancers and lymphoblastic lymphoma, it may be combined with agents such as cisplatin, etoposide, vinblastine, or other antineoplastic drugs. Mesna is always given alongside ifosfamide to protect the bladder from irritation and bleeding.

The specific combination of drugs will depend on the type of cancer being treated and your individual treatment plan.

Commonly tested with

Ifosfamide has been tested in combination with cisplatin and either etoposide or vinblastine (the VIP regimen) in clinical studies, especially for testicular cancer. In blood cancers, it is often studied as part of multi-drug regimens, sometimes with agents like doxorubicin, cytarabine, or methotrexate. These combinations are chosen to maximize the effectiveness of treatment and to target cancer cells in different ways.