Is continuous infusion of high-dose ifosfamide, a safe option? Drug review

Abstract

Higher doses of ifosfamide are required to treat Sarcoma, Bone sarcomas, germ cell tumours and lymphoma. Recent protocols are based on continuous infusion of ifosfamide for 5-14 days. But what is the evidence behind it? and experience?. We present a review of high dose ifosfamide and our small experience in giving ifosfamide, both as continuous infusion and as bolus dose, as per the respective protocol. We also report MESNA with its role in reducing the urotoxicity and required dose variation according to Ifosfamide dose. In children, however, we prefer bolus as compared to continuous infusion due to nephrotoxicity. In India, many oncologists prefer to give ifosfamide as bolus dose over 3-4 hr and the dose given is much lesser. Many a times they face myelotoxicity and other non haematological toxicities. This leads to negative impact on patient compliance and ultimately the treatment is not completed properly. If a proper dose infusion is planned, this toxicity may be reduced to some extent. We need an Indian data on continuous vs bolus dose ifosfamide. High dose ifosfmide is required for better treatment of soft tissue sarcoma.