ifosfamide


Also found in: Acronyms, Wikipedia.

ifosfamide

 [i-fos´fah-mīd]
an alkylating agent, one of the nitrogen mustards, which binds to protein and DNA and inhibits DNA synthesis. Used as an antineoplastic agent in treatment of leukemia, lymphoma, and cancers of the lung, ovary, testes, and other organs.

ifosfamide

Ifex, Mitoxana (UK)

Pharmacologic class: Alkylating agent, nitrogen mustard

Therapeutic class: Antineoplastic

Pregnancy risk category D

FDA Box Warning

• Give under supervision of physician experienced in using cancer chemotherapy, in facility with adequate diagnostic and treatment resources. Adverse urotoxic effects (especially hemorrhagic cystitis) and CNS toxicities (such as confusion and coma) have occurred; these effects may warrant drug discontinuation.

• Severe myelosuppression may occur.

Action

Alkylates DNA, interfering with replication and synthesis of susceptible cells and ultimately causing cell death

Availability

Injection: 1 g or 3 g in single-dose vials

Indications and dosages

Germ-cell testicular cancer

Adults: 1.2 g/m2/day by I.V. infusion over 30 minutes for 5 days. May repeat q 3 weeks or after recovery from hematologic toxicity.

Off-label uses

• Acute leukemia
• Breast, lung, ovarian, and pancreatic cancer
• Malignant lymphomas
• Sarcomas

Contraindications

• Hypersensitivity to drug
• Severe bone marrow depression
• Pregnancy or breastfeeding

Precautions

Use cautiously in:
• impaired renal or hepatic function, mild to moderate bone marrow depression.

Administration

• Follow facility policy for handling antineoplastic agents.
• Know that drug is usually given with other antineoplastics and hemorrhagic cystitis agent.
• To reconstitute, add sterile water or bacteriostatic water to vial, and shake gently.
• Mix 20 ml of diluent with 1-g vial or 60 ml of diluent with 3-g vial, to yield a concentration of 50 mg/ml. For smaller concentrations, dilute solution further with normal saline solution, dextrose 5% in water, lactated Ringer's solution, or sterile water.
• Administer I.V. slowly over at least 30 minutes.

Adverse reactions

CNS: drowsiness, confusion, ataxia, hallucinations, depressive psychosis, dizziness, disorientation, cranial nerve dysfunction, coma, seizures

CV: phlebitis

GI: nausea, vomiting, diarrhea, anorexia, stomatitis

GU: hematuria, bladder fibrosis, gonadal suppression, nephrotoxicity, hemorrhagic cystitis

Hematologic: anemia, leukopenia, thrombocytopenia, bone marrow depression

Metabolic: metabolic acidosis

Skin: alopecia

Other: infection, secondary neoplasms

Interactions

Drug-diagnostic tests.Hepatic enzymes, uric acid: increased levels

Platelets, white blood cells: decreased counts

Patient monitoring

• Monitor hematopoietic function tests (such as CBC with white cell differential) before therapy and weekly during therapy.
• Assess fluid intake and output. Ensure fluid intake of at least 2 L daily to prevent bladder toxicity.

Monitor urine output for hematuria and hemorrhagic cystitis. Administer mesna (protective drug), as indicated and prescribed.

Patient teaching

Tell patient to immediately report jaundice, unusual bleeding or bruising, bloody urine, pain on urination, fever, chills, sore throat, cough, difficulty breathing, unusual lumps or masses, mouth sores, or pain in flank, stomach, or joints.
• Instruct patient to maintain adequate hydration and nutrition. Advise him to drink 10 to 12 glasses of fluid each day.
• Inform patient that drug may cause hair loss.
• Advise both male and female patients to use reliable contraception during and immediately after therapy, because drug may cause severe birth defects.
• Urge patient to keep regular follow-up appointments for blood tests and monitoring of drug effects.
• As appropriate, review other significant and life-threatening adverse reactions and interactions, especially those related to the drugs and tests mentioned above.

i·fos·fa·mide

(ī-fos'fă-mīd),
A prodrug antineoplastic alkylating agent.

ifosfamide

/ifos·fa·mide/ (i-fos´fah-mīd) a cytotoxic alkylating agent of the nitrogen mustard group, in structure and actions similar to cyclophosphamide; used in the treatment of solid tumors of the testis, ovary, and lung as well as sarcomas.

ifosfamide

an antineoplastic alkylating agent.
indications This drug is used to treat testicular cancer, soft tissue sarcoma, Ewing's sarcoma, non-Hodgkin's lymphoma, lung sarcoma, and pancreatic sarcoma.
contraindications Pregnancy, bone marrow suppression, and known hypersensitivity to this drug prohibit its use.
adverse effects Adverse effects of this drug include facial paresthesia, fever, malaise, somnolence, confusion, depression, hallucinations, dizziness, disorientation, cranial nerve dysfunction, nausea, vomiting, anorexia, stomatitis, constipation, diarrhea, dysuria, urinary frequency, dermatitis, alopecia, and pain at the injection site. Life-threatening side effects include seizures, coma, hepatoxicity, hematuria, nephrotoxicity, hemorrhagic cystitis, thrombocytopenia, leukopenia, and anemia.

ifosfamide

Oncology An alkylating antineoplastic agent approved under an IND protocol as a 3rd-line therapy for germ-cell testicular malignancy; it is also used for cervical CA, soft tissue sarcomas Side effects Myelosuppression, encephalopathy, confusion, coma, hemorrhagic cystitis Treatment Hemorrhagic cystitis may respond to mesna, encephalopathy may respond to methylene blue

i·fos·fa·mide

(ī-fos'fă-mīd)
A prodrug antineoplastic alkylating agent.

ifosfamide

An ALKYLATING AGENT used as an anticancer drug. A brand name is Mitoxana.
References in periodicals archive ?
CytRx is currently evaluating aldoxorubicin in a global Phase 2b clinical trial in small cell lung cancer, a Phase 2 clinical trial in HIV-related Kaposi's sarcoma, a Phase 2 clinical trial in patients with late-stage glioblastoma (brain cancer), a Phase 1b trial in combination with ifosfamide in patients with soft tissue sarcoma, and a Phase 1b trial in combination with gemcitabine in subjects with metastatic solid tumors.
At best, doxorubicin and ifosfamide have objective response rates in sarcoma of 20% to 30% (4).
On day 2 of the ifosfamide therapy, the patient became sleepy and confused; he had generalized myoclonic jerks, muscle spasticity, and asterixis.
Palifosfamide offers a better safety profile than ifosfamide
Chemotherapy regimens included combinations predominantly of vincristine, cyclophoshamide, etopside, ifosfamide with the addition of doxorubicin, actinomycin, carboplatin and cisplatin.
Both studies combine standard doses of gemcitabine or ifosfamide with escalating doses of aldoxorubicin.
5] the present case is the first to document the outcomes of multiple chemotherapy regimens (VP-16, ifosfamide, cisplatin→doxorubicin, ifosfamideifosfamide, paclitaxel, and nedaplatin).
PharmaMar has five novel compounds: Yondelis(R) has received Authorization for Commercialization from the European Commission for advanced soft tissue sarcoma, after failure of anthracyclines and ifosfamide, or for patients who are unsuited to receive these agents.
35) Most recently, Zanon et al suggested that despite the general ineffectiveness of chemotherapy, the most active drugs in the control of tumor growth in malignant schwannoma are decarbazine, doxorubicin, and ifosfamide.
The proprietary Cell-in-a-Box[R] technology capsules, when used in combination with cytochrome P450 expressing cells, can be placed at the tumor site so that the cells inside the capsule can convert the drug ifosfamide.
CytRx is also evaluating aldoxorubicin in two Phase 2 clinical trials, one in patients with late-stage glioblastoma (GBM) and the other in HIV-related Kaposi's sarcoma, a global Phase 2b clinical trial in patients with relapsed small cell lung cancer, a Phase 1b trial in combination with ifosfamide in patients with soft tissue sarcoma, and a Phase 1b trial in combination with gemcitabine in patients with metastatic solid tumors.
Men with metastatic germ cell tumour at first salvage were treated with CDCT consisting of ifosfamide 1200 mg/m[sup.