{"entity":{"id":"ifosfamide","kind":"drug","name":"Ifosfamide","aka":[],"tldr":"Ifosfamide is an alkylating chemotherapy partnered with doxorubicin in sarcoma and with etoposide in Ewing sarcoma, given with a bladder-protecting drug.","summary":"Ifosfamide is an alkylating prodrug activated by CYP2B6 and CYP3A4 to a mustard that crosslinks DNA; its chloroacetaldehyde metabolite causes the characteristic encephalopathy and nephrotoxicity, and mesna uroprotection is mandatory to prevent haemorrhagic cystitis. Approved in 1988 for germ cell testicular cancer, it is standard off-label as the partner of doxorubicin in AIM for soft-tissue sarcoma, in MAP-IE for osteosarcoma, and with etoposide in VDC/IE for Ewing sarcoma, the regimen established by INT-0091. Febrile neutropenia occurred in 46% of patients on the AIM arm of EORTC 62012, encephalopathy in about 10% (treated with methylene blue) and haemorrhagic cystitis in about 5% even with mesna. It is a powerful alkylator whose use depends on protecting the bladder, kidneys and brain from its by-products.","status":"approved","asOf":"2026-09-07","wikipedia":"https://en.wikipedia.org/wiki/Ifosfamide","links":[{"label":"FDA label (DailyMed)","url":"https://dailymed.nlm.nih.gov/dailymed/search.cfm?query=Ifosfamide"}],"tags":[],"related":["mesna"],"cancers":["sarcoma","extremity-soft-tissue-sarcoma","undifferentiated-pleomorphic-sarcoma","malignant-peripheral-nerve-sheath-tumour","cns-germ-cell-tumours","node-positive-penile-cancer"],"sections":[],"technologies":["cytotoxic-chemotherapy"],"targets":[],"drugs":[],"companies":[],"institutions":[],"pathways":[],"terms":[],"trials":["euramos-1","nct06230224","nct05533775","nct06277154"],"people":[],"bottlenecks":[],"keyPapers":[],"journals":[],"dependsOn":[],"notes":[],"brand":"Ifex","modality":"Cytotoxic chemotherapy (alkylating agent)","mechanism":"Prodrug activated by CYP2B6/3A4 to an alkylating mustard causing DNA crosslinks; chloroacetaldehyde metabolite causes neuro- and nephrotoxicity.","approvals":[{"region":"US","year":1988,"indication":"Germ cell testicular cancer; widely used off-label in sarcoma"}],"mechanismSteps":[],"dosing":{"route":"IV","schedule":"9-10 g/m2 per cycle over 3-5 days with mesna (sarcoma); 1.8 g/m2 × 5 days with etoposide (Ewing)","monitoring":"Urinalysis for haematuria, renal function, encephalopathy (methylene blue), counts"},"toxicity":[{"event":"Febrile neutropenia (with doxorubicin)","grade3PlusPct":46,"note":"EORTC 62012 AIM arm"},{"event":"Encephalopathy","anyGradePct":10},{"event":"Haemorrhagic cystitis","anyGradePct":5,"note":"with mesna"}],"access":[],"regulatoryEvents":[]},"route":"/drugs/ifosfamide/","neighbours":{"drug":[{"id":"mesna","kind":"drug","name":"Mesna","route":"/drugs/mesna/"}],"cancer":[{"id":"burkitt-lymphoma","kind":"cancer","name":"Burkitt lymphoma","route":"/cancers/burkitt-lymphoma/"},{"id":"cns-germ-cell-tumours","kind":"cancer","name":"Central 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