title: Ambulatory administration of 5-day infusion ifosfamide+mesna: a pilot study in sarcoma patients.
abstract: OBJECTIVE
  Ifosfamide is a cornerstone of chemotherapy in bone and soft-tissue sarcoma. Results of pharmacokinetic studies indicate that the optimal schedule of ifosfamide should be repeated doses over several days. With the development of 5-day infusion devices, we developed and evaluated a 5-day infusion regimen of ifosfamide in sarcoma patients in the outpatient setting.
  
  
  METHODS
  Sarcoma patients requiring chemotherapy after at least one doxorubicin-based line were enrolled in this study. Ifosfamide+mesna was administered as 1:1 concentration for a total of 6 g/m2 of each over 5 days (i.e. 1.2 g/m2 per day as continuous infusion) every 3 weeks. Patients were treated until progression or limiting toxicity, and salvage surgery was attempted when possible. An economic study was run comparing ifosfamide plus mesna as a 5-day infusion regimen and conventional Ifosfamide regimen.
  
  
  RESULTS
  Thirteen sarcoma patients were evaluable. The median number of cycles per patient was 6 (range, 1-8), for a total of 69 cycles. No acute encephalopathy or aggravation of renal function was noted. Acute grade 3 and 4 haematological toxicities were observed in 11.6 and 1.4% of patients, respectively without febrile neutropenia. Median time to progression survival and overall survival were 8.7 and 21.5 months, respectively. Total cost per cycle for a 2-m2 patient body surface area was ambulatory infusion=1,891 euros and conventional ifosfamide=6,256 euros.
  
  
  CONCLUSIONS
  The combination of ifosfamide and mesna as a continuous infusion over 5 days is feasible and well tolerated in the outpatient setting using infusion device. Its very favourable cost-effectiveness invites to further develop this approach.
authors: Department of Medical Oncology, Teaching Hospital Cochin, AP-HP, Université Paris Descartes, 27, rue du faubourg Saint Jacques, 75014, Paris, France.
authors: Romain
authors: R
authors: Coriat
authors: Olivier
authors: O
authors: Mir
authors: Sandra
authors: S
authors: Camps
authors: Stanislas
authors: S
authors: Ropert
authors: Bertrand
authors: B
authors: Billemont
authors: Mahaut
authors: M
authors: Leconte
authors: Frédérique
authors: F
authors: Larousserie
authors: Philippe
authors: P
authors: Anract
authors: Jérôme
authors: J
authors: Alexandre
authors: François
authors: F
authors: Goldwasser
mesh_terms: D000328:Adult; D000368:Aged; D000740:Anemia / Q000139:chemically induced; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000009:adverse effects / Q000627:therapeutic use*; D003967:Diarrhea / Q000139:chemically induced; D004334:Drug Administration Schedule; D005260:Female; D006801:Humans; D007069:Ifosfamide / Q000008:administration & dosage / Q000009:adverse effects; D007260:Infusion Pumps; D008297:Male; D015080:Mesna / Q000008:administration & dosage / Q000009:adverse effects; D008875:Middle Aged; D009325:Nausea / Q000139:chemically induced; D010045:Outpatients; D010865:Pilot Projects; D012509:Sarcoma / Q000188:drug therapy* / Q000473:pathology; D016019:Survival Analysis; D013997:Time Factors; D016896:Treatment Outcome; D014839:Vomiting / Q000139:chemically induced
chemical_list: D015080:Mesna; D007069:Ifosfamide