Ifosfamide in the treatment of germ cell tumors

Abstract

Ifosfamide is currently the third most active agent in the treatment of germ cell cancer, behind cisplatin and etoposide. Ifosfamide has single-agent activity comparable to etoposide in very poor-prognosis, cisplatin-refractory disease. In the salvage setting, ifosfamide-based combination chemotherapy can be expected to achieve disease-free status in approximately 50% of cisplatin-sensitive testicular cancer patients, although half of these patients will eventually relapse. As first-line therapy in previously untreated poor-risk patients, ifosfamide-based chemotherapy is therapeutically equivalent to standard therapy but associated with increased toxicity, especially myelosuppression. The role of high-dose ifosfamide in dose-intensive carboplatin/etoposide regimens for the treatment of recurrent disease is unknown and awaits clarification in future research. Current research with this drug continues primarily in the realm of refining ifosfamide-based salvage therapy.