Ifosfamide

Definition

Ifosfamide is an anticancer (antineoplastic) agent. It also acts as a suppressor of the immune system. It is available under the brand name IFEX.

Purpose

Ifosfamide is approved by the Food and Drug Administration (FDA) to treat germ cell testicular cancer . It is generally prescribed in combination with another medicine (mesna ), which is used to prevent the bladder problems that may be caused by ifosfamide alone.

Ifosfamide also has activity against other cancers and is prescribed in practice for these cancer types:

• pancreatic cancer
• stomach cancer
• soft-tissue sarcoma
• Ewing's sarcoma
• acute and chronic lymphocytic leukemia
• bladder cancer
• bone cancer
• breast cancer
• cervical cancer
• head and neck cancers
• lung cancer
• lymphomas
• neuroblastomas
• ovarian cancer
• Wilms' tumor

Description

Ifosfamide chemically interferes with the synthesis of the genetic material (DNA and RNA) of cancer cells by cross-linking of DNA strands, which prevents these cells from being able to reproduce and continue the growth of the cancer.

Recommended dosage

Ifosfamide may only be taken as an injection into the vein. The dosage prescribed varies widely depending on the patient, the cancer being treated, and whether or not other medications are also being taken. Examples of common doses for adults are: 50 mg per kg per day, or 700 to 2000 mg per square meter of body surface area for five days every three to four weeks. Another alternative regimen is 2400 mg per square meter of body surface area for three days or 5000 mg per square meter of body surface area as a single dose every three to four weeks. Examples of common dosing regimens for children are: 1200 to 1800 mg per square meter of body surface area per day for three to five days every 21 to 28 days; 5000 mg per square meter of body surface area once every 21 to 28 days; or 3000 mg per square meter of body surface area for two days every 21 to 28 days.

Precautions

Ifosfamide can cause an allergic reaction in some people. Patients with a prior allergic reaction to ifosfamide should not take this drug.

Ifosfamide should always be taken with plenty of fluids.

Ifosfamide can cause serious birth defects if either the man or the woman is taking this drug at the time of conception or if the woman is taking this drug during pregnancy. Contraceptive measures should be taken by both men and women while on this drug. Because ifosfamide is easily passed from mother to child through breast milk, breast feeding is not recommended during treatment.

Ifosfamide suppresses the immune system, and its excretion from the body is dependent on a normal functioning kidney and liver. For these reasons, it is important that the prescribing physician is aware of any of the following pre-existing medical conditions:

• a current case of, or recent exposure to, chicken pox
• herpes zoster (shingles)
• all current infections
• kidney disease
• liver disease

Also, because ifosfamide is such a potent immunosuppressant, patients taking this drug must exercise extreme caution to avoid contracting any new infections.

Side effects

Inflammation and irritation of the bladder, causing blood in the urine, is the most common and severe side effect of ifosfamide. However, this side effect can be prevented and controlled with the administration of the bladder protectant drug mesna and vigorous hydration with intravenous fluids before, during, and after chemotherapy . Patients should also urinate frequently (at least every 2 hours) to enhance removal of the drug from the body, and drink 2 to 3 liters of fluids a day for 2 to 3 days after discontinuation of the chemotherapy.

Other common side effects of ifosfamide are:

• confusion
• hallucinations
• drowsiness
• dizziness
• temporary hair loss (alopecia )
• increased susceptibility to infection
• increased risk of bleeding (due to a decrease of the platelets involved in the clotting process)
• nausea and vomiting (can be prevented with prescribed antiemetics)

Less common side effects include:

• increased coloration (pigmentation) of the skin and fingernails
• loss of appetite (anorexia )
• diarrhea
• nasal stuffiness
• skin rash, itching , or hives

A doctor should be consulted immediately if the patient experiences any of these side effects:

• painful or difficult urination
• increase in frequency or feeling of urgency to urinate
• blood in the urine
• blood in the stool
• severe diarrhea
• mental status changes such as confusion, drowsiness, or hallucinations
• signs of infection such as cough, sore throat, fever and chills
• shortness of breath
• chest or abdominal pain
• pain in the lower back or sides
• unusual bleeding or bruising
• tiny red dots on the skin

Interactions

Ifosfamide should not be taken in combination with any prescription drug, over-the-counter drug, or herbal remedy without prior consultation with a physician.

Paul A. Johnson, Ed.M.

KEY TERMS

Antineoplastic

—A drug that prevents the growth of a neoplasm by interfering with the maturation or proliferation of the cells of the neoplasm.

Neoplasm

—New abnormal growth of tissue.

ifosfamide (I-fos-fă-myd) n. a cytotoxic drug used in the treatment of malignant disease, particularly sarcomas, testicular tumours, and lymphomas. It is administered intravenously by injection or infusion. Trade name: Mitoxana.