Ifosfamide in non-small cell lung cancer

Ifosfamide is an analogue of cyclophosphamide that is active against a variety of solid tumors, including non-small cell lung cancer. In preclinical studies, ifosfamide had yielded an average response rate of 20% to 25% and a median length of survival of 4 to 5 months. With the introduction of mesna, hematologic toxicity is the major toxicity associated with ifosfamide use. Response is not affected by the schedule of drug administration, nor is the response rate compromised by oral delivery of ifosfamide. Neurotoxicity is greater with oral administration, however. Ifosfamide has been used in combination with many different agents, including cisplatin and etoposide and newer drugs like vinorelbine and paclitaxel. The results of the combination studies indicate improved response rates. However, results of randomized phase II trials suggest there may be no survival benefit with the addition of ifosfamide to establish drug combinations. Further study of ifosfamide in combination with newer drugs is appropriate.