Ifosfamide in non-small cell lung cancer: a review

In recent years, ifosfamide has proven to be one of the most effective cytostatic drugs in the treatment of non-small cell lung cancer. Single-agent studies have demonstrated response rates of 15% to 30%. Combinations containing ifosfamide together with one or two other cytostatic agents yield overall response rates of 30% to 45%, with 5% to 10% complete remissions. For this purpose, ifosfamide has proven to be an ideal constituent, especially since the routine use of mesna uroprotection has significantly reduced its toxicity. As myelosuppression is now the primary dose-limiting toxicity, further investigations are directed toward the question of whether adjuvant administration of hematopoietic growth factors can improve treatment results by allowing increased dose intensity. This seems to be particularly important in patients with malignancies that respond poorly to cytostatic chemotherapy to determine whether survival can be significantly prolonged. Further studies with ifosfamide, moreover, should include neoadjuvant investigations in patients with stages II and III disease or its combination with other treatment modalities.