Ifosamide

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Aditya Govindavarjhulla, M.B.B.S. [2]

Overview

Ifosfamide (pronounced eye.fos'.fa.mide) (also marketed as Mitoxana and Ifex) is a nitrogen mustard alkylating agent used in the treatment of cancer. It is sometimes abbreviated "IFO".

Uses

It is given as a treatment for a variety of cancers, including:

• Testicular cancer
• Breast cancer
• Lymphoma (Hodgkin's and non-Hodgkin's)
• Soft tissue sarcoma
• Osteogenic sarcoma (bone cancer)
• Lung cancer
• Cervical cancer
• Ovarian cancer

Administration

It is a white powder which, when prepared for use in chemotherapy, becomes a clear, colorless fluid. The delivery is intravenous.

Ifosfamide is often used in conjunction with mesna to avoid internal bleeding in the patient, in particular hemorrhagic cystitis. Ifosfamide is given quickly, and in some cases can be given in as little as an hour.

Toxicity

A common and dose-limiting side effect isencephalopathy (brain dysfunction). It occurs in some form in up to 50% of people receiving the agent. The reaction is probably mediated by chloroacetaldehyde, one of the breakdown products of the ifosfamide molecule, which has chemical properties similar toacetaldehyde and chloral hydrate.

Side/Adverse effects

• Encephalopathy

• Delirium

• Psychosis

• Nonconvulsive status epilepticus

• Coma

• Normal anion gap acidosis, specifically Renal tubular acidosis type 2.

• Hemorrhagic cystitis

Treatment

The most effective treatment for severe (grade III-IV) encephalopathy is an intravenous solution of methylene blue, which appears to shorten the duration of encephalopathy. Other treatments include albuminand thiamine, and dialysis as a rescue modality.