Cyclophosphamide (Cytoxan)

General information

Class/mechanism: Alkylating agent; transformed primarily in the liver to active metabolites which alkylate and crosslink DNA.
Route: IV, PO
Extravasation: irritant or neutral, depending on reference; n/a

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, Medscape,UpToDate (courtesy of Lexicomp), or the prescribing information.

Diseases for which it is established (work in progress)

• Non-Hodgkin lymphoma
  • Follicular lymphoma
  • Mantle cell lymphoma
  • Peripheral T-cell lymphoma

Diseases for which it is used

• Acquired coagulopathy
• Acute myeloid leukemia
• Adult T-cell leukemia-lymphoma
• Anaplastic glioma
• Anaplastic large cell lymphoma
• B-cell acute lymphoblastic leukemia
• Bladder cancer
• Breast cancer
• Burkitt lymphoma
• Central nervous system (CNS) cancer
• Chronic lymphocytic leukemia
• Chronic myeloid leukemia
• CNS lymphoma
• Diffuse large B-cell lymphoma
• Ewing sarcoma
• Gestational trophoblastic neoplasia
• Glioblastoma
• HIV-associated lymphoma
• Hodgkin lymphoma
• Hodgkin lymphoma, nodular lymphocyte-predominant
• Large granular lymphocytic leukemia
• Light-chain (AL) amyloidosis
• Marginal zone lymphoma
• Mediastinal gray-zone lymphoma
• Medulloblastoma
• Multiple myeloma
• Neuroblastoma
• Osteosarcoma
• Pheochromocytoma
• Plasma cell leukemia
• Post-transplant lymphoproliferative disorder
• Primary mediastinal B-cell lymphoma
• Prostate cancer
• Rhabdomyosarcoma
• T-cell acute lymphoblastic leukemia
• Thymoma
• Transformed lymphoma
• Waldenström macroglobulinemia

Diseases for which it was used

• Non-small cell lung cancer
• Ovarian cancer
• Renal cell carcinoma
• Small cell lung cancer
• Testicular cancer

Patient drug information

• Cyclophosphamide (Cytoxan) package insert
• Cyclophosphamide (Cytoxan) patient drug information (Chemocare)
• Cyclophosphamide (Cytoxan) patient drug information (UpToDate)

History of changes in FDA indication

• 1959-11-16: initial FDA approval
• 2012-03-31 (oldest label available at Drugs @ FDA): Approved for malignant lymphomas (Stages III and IV of the Ann Arbor staging system), Hodgkin’s disease, lymphocytic lymphoma (nodular or diffuse), mixed-cell type lymphoma, histiocytic lymphoma, Burkitt lymphoma; multiple myeloma, leukemias: Chronic lymphocytic leukemia, chronic granulocytic leukemia (it is usually ineffective in acute blastic crisis), acute myelogenous and monocytic leukemia, acute lymphoblastic (stem-cell) leukemia in children (cyclophosphamide given during remission is effective in prolonging its duration); mycosis fungoides (advanced disease); neuroblastoma (disseminated disease); adenocarcinoma of ovary; retinoblastoma; carcinoma of the breast (No supporting studies are cited)

History of changes in PMDA indication

• 2019-03-26: New indication for the treatment prior to tumor-specific T-cell infusion therapy.
• 2021-08-21: new indication and a new dosage for the treatment of systemic AL amyloidosis.

Also known as

• Code names: Asta B 518, B-518, WR-138719
• Generic names: CP monohydrate, CPM, cyclophosphamid monohydrate, cyclophosphamide monohydrate
• Brand names:

Synonyms
Alkyloxan	Biodoxan	Carloxan	Ciclofosfamida	Ciclokebir	Cicloxal	Clafen	Claphene
Cyclam	Cycloblastin	Cycloblastine	CYCLO-cell	Cycloferon	Cyclomide	Cyclophar	Cyclophospham
Cyclophosphamid	Cyclophosphane	Cyclostin	Cyclostine	Cyclotox	Cycloxan	Cycram	Cydoxan
Cyklofosfamid	Cyphos	Cytophosphan	Cytoxan	Cytoxan Lyophilized	Endoxan	Endoxan-N	Endoxana
Enduxan	Formitex	Fosfaseron	Genoxal	Genuxal	Hidrofosmin	Ledoxan	Ledoxina
Mitoxan	Neophos	Neosar	Oncomide	Oncophos	Procytox	Revimmune	Sendoxan
Siklofos	Syklofosfamid	Tymtran	Zuviphos	Zycram	Zytoxan