ifosfamide

Overview

Ifosfamide is an alkylating agent that cross-links DNA after activation by hepatic cytochrome P450 enzymes. It is used in salvage regimens for germ cell tumors (GCT) including TIP (paclitaxel + ifosfamide + cisplatin) and VIP (vinblastine/etoposide + ifosfamide + cisplatin), typically after failure of first-line BEP chemotherapy. Hemorrhagic cystitis is a key toxicity, prevented by mesna co-administration.

Evidence in the corpus

• Component of TIP/VIP salvage regimens received by 20% of 180 advanced GCT patients in cisplatin-resistance biomarker study; TP53 and MDM2 alterations predicted shorter progression-free survival (HR 1.83; 95% CI 1.12-2.98; P=.016) independent of IGCCCG risk model PMID:27646943
• Component of ISG/SSG IV protocol (vincristine, doxorubicin, ifosfamide, etoposide) in EWSR1::BEND2 bladder sarcoma; nephrotoxicity with ifosfamide-containing regimen led to switch to docetaxel + gemcitabine PMID:28199314.

Resistance mechanisms

Cancer types (linked)

• GCT

Sources

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