Ifosfamide: a clinical review

Abstract

Although ifosfamide first underwent clinical trials 15 years ago, it has largely been ignored by the American oncology community until the last few years. Earlier concerns about dose-limiting hemorrhagic cystitis have been mitigated by the development of effective urothelial protectors such as mesna. Furthermore, ifosfamide is not completely cross-resistant with cyclophosphamide. Ifosfamide has activity in a variety of disseminated refractory solid tumors that do not traditionally respond to conventional alkylating agent therapy, specifically refractory germ cell tumors, soft tissue sarcomas, and malignant lymphomas. The decreased myelosuppression and lack of apparent cross-resistance compared with cyclophosphamide make ifosfamide an ideal drug for inclusion in combination chemotherapy. While clarification of the differences between ifosfamide and cyclophosphamide is ongoing, ifosfamide may eventually replace cyclophosphamide in conventional combination chemotherapy regimens for a variety of solid tumors. At present, it has clear-cut major activity in refractory germ cell tumors and has become an integral component of a curative salvage regimen.