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Ifosfamide is a parenterally administered alkylating agent similar to cyclophosphamide. The chemical name of it is 3-(2-chloroethyl)-2-[(2-chloroethyl)amino]tetrahydro-2H-1,3,2-oxazaphospholane-2-oxide and used for a variety of cancers. The structure is shown in fig. 1.

Structure of ifosfamide

Fig. 1 Structure of ifosfamide

Application in the treatment of cancer

Ifosfamide has been effectively employed in the treatment of multiple cancers, including testicular cancer, soft tissue sarcoma, osteosarcoma, bladder cancer, small cell lung cancer, non-Hodgkin lymphoma, Hodgkin lymphoma, epithelial ovarian cancer, cervical carcinoma and germ cell carcinoma of the ovary[1]. Among all these cancers, the Food and Drug Administration (FDA) has approved ifosfamide only for testicular cancer. A study analyzed the therapy outcomes of 39 patients with testicular cancer who were treated with ifosfamide as a monotherapy from 1970-1977. The results showed that 16/39 patients (41%) were tumor-free after chemotherapy and operation and 6 of them survived for more than 5 years. This amounts to a curative rate of 15%[2].

  • Mechanism of action

Ifosfamide is an inactive compound that belongs to the class of oxazaphosphorine alkylating agents. It is metabolized in the liver by CYP450 enzymes to active metabolites (phosphoramide mustard derivatives and acrolein) that bind to DNA and inhibit DNA synthesis in two ways. First, these active metabolites cause cell damage and apoptosis by forming interstrand or intrastrand DNA crosslinks. Second, these active metabolites upregulate reactive oxygen species (ROS), resulting in irreparable DNA damage and the cessation of protein formation. More importantly, ifosfamide is cytotoxic, so its antitumor activity is stronger than other alkylating agents.

  • Side effects

Side effects of ifosfamide are dose-related and can be described based on the affected system.

Table 1. Side effects of ifosfamide and the occurring rate in different affected systems

Adverse EventEdaravone (n = 184) %Placebo (n = 184) %
Renal systemHematuria (used alone)90%
Cardiac systemArrhythmiaUnder 10%
Hepatic systemElevated liver enzymes, hepatic vein-occlusive-
Hematologic systemLeukopenia, anemia, and thrombocytopenia30-50%
Dermatologic systemAlopecia90%
Gastrointestinal systemNausea and vomitingOver 50%
Central nervous systemEncephalopathy15%
Endocrine and metabolic systemsMetabolic acidosis30%

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  1. Buda, A., et al. Role of ifosfamide in cervical cancer: an overview. Oncology. 2003, 65(suppl 2): 63-66.
  2. Hartlapp, J. H., Weißbach, L. Ifosfamide monotherapy in testicular cancer. Journal of Cancer Research and Clinical Oncology. 1986.