Is there a maximum ifosfamide cumulative dose in patients with normal kidney function?
When offering ifosfamide / etoposide for relapsed osteosarcoma, patient is being given 2.8mg/m2 of ifosfamide. Is 6-8 cycles exceeding any known lifetime dose limit? The increased number of cycles are given in the setting of high risk relapse (early/multifocal), after aggressive surgery, and having tolerated the first few cycles well.
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What is the maximum life time cumulative dose of ifosfamide?
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Pediatric Hematology/Oncology · Mayo Clinic
Answered on
Here are a number of references from osteosarcoma as well as rhabdo patients. There is no "lifetime limit" but the more you give the higher the risk of renal Fanconis or other renal dysfunction. 72 g/m2 is generally well-tolerated, but not in everyone. There is also no data comparing 14 g/m2/cycle to 9 g/m2 per cycle in osteosarcoma. Moreover, you may be limited by marrow tolerance not just renal tolerance -- I think it will become obvious when the patient cannot tolerate more -- I usually tell families 6-8 cycles (maybe even less) depending on how the patient tolerates it. Of course, you will also run the risk of MDS with alkylator and VP16.
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