Ifosfamide (Ifex)

General information

Class/mechanism: Nitrogen mustard, alkylator. Metabolites of ifosfamide interact with DNA to produce phosphotriesters and formation of DNA cross-links. Ifosfamide requires metabolic activation by microsomal liver enzymes to form its active metabolites.
Route: IV
Extravasation: irritant or neutral, depending on reference

• A protective agent such as Mesna (Mesnex) should be used concurrently with ifosfamide to help prevent hemorrhagic cystitis.

For conciseness and simplicity, HemOnc.org currently will focus on treatment regimens and not list information such as: renal/hepatic dose adjustments, metabolism (including CYP450), excretion, monitoring parameters (although this will be considered for checklists), or manufacturer. Instead, for the most current information, please refer to your preferred pharmacopeias such as Micromedex, Lexicomp, UpToDate (courtesy of Lexicomp), or the prescribing information.

Diseases for which it is established (work in progress)

• Osteosarcoma
• Testicular cancer

Diseases for which it is used

• B-cell acute lymphoblastic leukemia, Ph-positive, pediatric
• Burkitt lymphoma
• CNS lymphoma
• Cervical cancer
• Diffuse large B-cell lymphoma
• Endometrial cancer
• Ewing sarcoma
• Extranodal NK- and T-cell lymphoma, nasal type
• HIV-associated lymphoma
• Classical Hodgkin lymphoma
• Mantle cell lymphoma
• Neuroblastoma
• NK- and T-cell lymphoma
• Penile cancer
• Rhabdomyosarcoma
• Soft tissue sarcoma
• Small cell lung cancer
• Thymoma
• T-cell acute lymphoblastic leukemia, pediatric

Diseases for which it was used

• Non-small cell lung cancer

Patient drug information

• Ifosfamide (Ifex) package insert
• Ifosfamide (Ifex) patient drug information (Chemocare)
• Ifosfamide (Ifex) patient drug information (UpToDate)

History of changes in FDA indication

• 1988-12-30: Initial approval in combination with certain other approved antineoplastic agents for third-line chemotherapy of germ cell testicular cancer. It should ordinarily be used in combination with a prophylactic agent for hemorrhagic cystitis, such as mesna. (Based on Loehrer et al. 1986)

History of changes in EMA indication

• 1976-07-13: EURD

History of changes in PMDA indication

• 2012-03-21: New additional indication and a new dosage for the treatment of malignant lymphoma.

Also known as

• Brand names:

Synonyms
Alquimid	Duvaxan	Fentul	Fosfidex	Haloxan
Holoxan	Holoxane	Ifex	IFO Cell	Ifocris
Ifolem	Ifomida	Ifomide	Ifos	Ifosfamida
Ifoxan	IFX	Ipamide	Isophosphamide	Isoxan
Macdafen	Mitoxana	Tronoxal