Ifosfamide

• Type: Anticancer (chemotherapy) drug

• Drug Class: Alkylating agent (nitrogen mustard derivative)

• Form: Sterile powder or solution for intravenous (IV) infusion

How It Works

• Ifosfamide is a prodrug that gets activated in the liver by cytochrome P450 enzymes.

• The active metabolites form DNA cross-links within cancer cells, preventing DNA replication and transcription.

• This leads to cell cycle arrest and cell death, particularly in rapidly dividing tumor cells.

Common Uses

Ifosfamide is widely used for:

• Testicular cancer (especially in refractory or relapsed cases)

• Soft tissue sarcomas

• Lung cancer (small cell and non-small cell)

• Cervical cancer

• Ovarian cancer

• Lymphomas

• Pediatric tumors (such as Wilms’ tumor, rhabdomyosarcoma, Ewing’s sarcoma)

Administration

• Given intravenously over several hours, often as part of combination chemotherapy regimens

• Always co-administered with Mesna (a uroprotectant) to prevent hemorrhagic cystitis caused by toxic metabolites

Advantages

• Effective against a wide range of solid tumors and hematologic cancers

• Can be combined with other chemotherapy agents for improved response rates

• Can be used in both adults and children under supervision

Possible Side Effects

Common:

• Nausea, vomiting, loss of appetite

• Hair loss (alopecia)

• Low white blood cell counts (neutropenia) → risk of infection

• Fatigue

Important/Rare but Serious:

• Hemorrhagic cystitis (bladder bleeding) – prevented with Mesna

• Kidney toxicity (tubular damage, electrolyte imbalances)

• Neurotoxicity (confusion, drowsiness, seizures – reversible but serious)

• Risk of secondary malignancies with prolonged use

Precautions

• Hydration is essential to flush out toxic metabolites and protect the bladder

• Kidney function and electrolytes should be monitored regularly

• Blood counts must be monitored before each cycle

• Avoid use during pregnancy (risk of fetal harm)

• Patients should report neurological symptoms (confusion, hallucinations) immediately