Ifosfamide, sold under the brand name Ifex among others, is a
chemotherapy medication
Chemotherapy (often abbreviated chemo, sometimes CTX and CTx) is the type of cancer treatment that uses one or more anti-cancer drugs ( chemotherapeutic agents or alkylating agents) in a standard regimen. Chemotherapy may be given with a cura ...
used to treat a number of types of cancer.
[ This includes ]testicular cancer
Testicular cancer is cancer that develops in the testicles, a part of the male reproductive system. Symptoms may include a lump in the testicle or swelling or pain in the scrotum. Treatment may result in infertility.
Risk factors include an c ...
, soft tissue sarcoma
A soft-tissue sarcoma (STS) is a malignant tumor, a type of cancer, that develops in soft tissue. A soft-tissue sarcoma is often a painless mass that grows slowly over months or years. They may be superficial or deep-seated. Any such unexplained ...
, osteosarcoma
An osteosarcoma (OS) or osteogenic sarcoma (OGS) is a cancerous tumor in a bone. Specifically, it is an aggressive malignant neoplasm that arises from primitive transformed cells of mesenchyme, mesenchymal origin (and thus a sarcoma) and that exhi ...
, bladder cancer
Bladder cancer is the abnormal growth of cells in the bladder. These cells can grow to form a tumor, which eventually spreads, damaging the bladder and other organs. Most people with bladder cancer are diagnosed after noticing blood in thei ...
, small cell lung cancer
Small-cell carcinoma, also known as oat cell carcinoma, is a type of highly malignant cancer that most commonly arises within the lung, although it can occasionally arise in other body sites, such as the cervix, prostate, and gastrointestinal tr ...
, cervical cancer
Cervical cancer is a cancer arising from the cervix or in any layer of the wall of the cervix. It is due to the abnormal growth of cells that can invade or spread to other parts of the body. Early on, typically no symptoms are seen. Later sympt ...
, and ovarian cancer
Ovarian cancer is a cancerous tumor of an ovary. It may originate from the ovary itself or more commonly from communicating nearby structures such as fallopian tubes or the inner lining of the abdomen. The ovary is made up of three different ...
.[ It is administered by intravenous, injection into a vein.][ Other severe side effects include bone marrow suppression and decreased level of consciousness.][ Use during pregnancy will likely result in harm to the baby.][ Ifosfamide is in the alkylating antineoplastic agent, alkylating agent and nitrogen mustard family of medications.][ It works by disrupting the duplication of DNA and the creation of RNA.][
Ifosfamide was approved for medical use in the United States in 1987.][ It is on the WHO Model List of Essential Medicines, World Health Organization's List of Essential Medicines.]
Medical uses
It is given as a treatment for a variety of cancers, including:
* Testicular cancer
* Breast cancer
* Lymphoma (Hodgkin and non-Hodgkin)
* Soft tissue sarcoma
* Osteosarcoma or bone tumor
* Lung cancer
* Cervical cancer
* Ovarian cancer
Administration
It is a white Powder (substance), 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 as quickly as an hour.
Mechanism of action
Ifosfamide is a DNA-damaging alkylating agent, belonging to the same class of chemotherapy drugs as cyclophosphamide. It is a prodrug, meaning that It has to be converted by CYP450 into its main active metabolites-(Iso)phosphoramide mustards. These metabolites form DNA cross links mainly at Guanine N-7 positions.
Side effects
Hemorrhagic cystitis is rare when ifosfamide is given with mesna. A common and dose-limiting side effect is encephalopathy (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 to acetaldehyde and chloral hydrate. The symptoms of ifosfamide encephalopathy can range from mild (difficulty concentrating, fatigue), to moderate (delirium, psychosis), to severe (Status epilepticus#Nonconvulsive, nonconvulsive status epilepticus or coma). In children, this can interfere with neurological development. Apart from the brain, ifosfamide can also affect peripheral nerves. The severity of the reaction can be classified according to either the National Cancer Institute or the Meanwell criteria (grade I–IV). Previous brain problems and low levels of albumin in the blood increase the likelihood of ifosfamide encephalopathy. In most cases, the reaction resolves spontaneously within 72 hours. If it develops during an infusion of the drug, discontinuing the infusion is advised. 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; the exact mechanism of action of methylene blue is unclear. In some cases, methylene blue may be used as a prophylaxis before further doses of ifosfamide are administered. Other treatments include albumin and thiamine, and Kidney dialysis, dialysis as a rescue modality.]
References
{{Authority control
Oxazaphosphinans
Nitrogen mustards
Phosphorodiamidates
Chloroethyl compounds
World Health Organization essential medicines
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