High-dose ifosfamide in the treatment of sarcomas of soft tissues and bone

Ifosfamide is an alkylating agent with clinical activity in the treatment of sarcomas, and data support a dose-response relationship in this disease. Attaining a clinical response can be a significant end point in sarcomas because such a response may allow function-sparing surgery or improved surgical resection of bulky primary tumors. Studies have shown that higher response rates can be obtained in sarcomas using dose-intensified chemotherapy than with conventional-dose chemotherapy. Although the early data using high-dose ifosfamide in the treatment of sarcomas are promising, the median durations of response have been less than 1 year. The continuing advances in supportive care technology will facilitate the ability to conduct large-scale trials in sarcomas using dose-intensified chemotherapy. The aim of these trials should be to optimize the dosing and antineoplastic efficacy of ifosfamide as a single agent and in combination regimens.