Holoxan (Farmitalia Carlo Erba)
500 mg, 1 g and 2 g in single dose vials
Indication: tumour chemotherapy
Ifosfamide is an alkylating agent similar to cyclophosphamide. It has anti-tumour activity in sarcomas, lymphomas and germ cell tumours, and may have some activity in other tumours e.g. cervical carcinoma.
After the drug is given intravenously, it is activated in the liver. The active metabolite affects nucleic acids and protein synthesis and leads to the death of the cell. Most of the dose is excreted in the urine and urotoxicity can be a major problem.
As haemorrhagic cystitis occurs frequently, ifosfamide should be given with a uroprotective drug (see 'Mesna' below). If a uroprotector is used, myelo suppression becomes the dose-limiting toxicity. Leucopenia is observed commonly and has been used as a guide to treatment. Anaemia and thrombocytopenia can also occur.
Other adverse effects include alopecia, nausea, vomiting and a potentially fatal central nervous system toxicity.