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Combined intravenous and oral mesna in outpatients treated with ifosfamide
M P Goren1, L M McKenna, T L Goodman
1Department of Pathology and Laboratory Medicine, St. Jude Children's Research Hospital, Memphis, Tennessee 38105, USA.
Purpose:
To prevent hemorrhagic cystitis, mesna is typically injected intravenously (i.v.) at the time of an ifosfamide dose and 4 and 8 h later. To simplify outpatient ifosfamide therapy, we gave the second and third mesna doses orally.
Methods:
The mesna doses (400 or 600 mg/m2) were 40% (w/w) of each ifosfamide dose (1.0 or 1.5 g/m2), which was given daily for 5 days. We evaluated urinary mesna excretion and plasma concentrations in ten patients from the beginning of mesna infusion until the time of the second oral dose. The first oral dose was administered at hour 2 in the last six patients to allow time for absorption of mesna.
Results:
The rate and amount of mesna excretion was less variable over time and among patients after oral than after i.v. administration. No macrohematuria was observed in these ten patients nor in an additional 50 patients given oral mesna at hours 2 and 8 during at least two cycles of ifosfamide therapy.
Conclusion:
These pharmacokinetic and clinical efficacy data support the use of a combined regimen of i.v. and oral mesna to simplify outpatient ifosfamide administration.
Insights
Oral mesna simplifies ifosfamide therapy by reducing hemorrhagic cystitis. A combined intravenous and oral mesna regimen is effective and convenient for outpatient treatment.
Area of Science:
- Oncology
- Pharmacology
- Urology
Background:
- Ifosfamide chemotherapy can cause hemorrhagic cystitis.
- Mesna is administered intravenously to prevent this side effect.
- Current mesna protocols require multiple intravenous injections, complicating outpatient therapy.
Purpose of the Study:
- To evaluate the efficacy and pharmacokinetics of a simplified mesna regimen.
- To determine if oral mesna can replace some intravenous doses during ifosfamide therapy.
- To assess the feasibility of combined intravenous and oral mesna for outpatient use.
Main Methods:
- Ten patients received ifosfamide with a combination of intravenous and oral mesna doses.
- Urinary mesna excretion and plasma concentrations were measured.
- Fifty additional patients received oral mesna at 2 and 8 hours post-ifosfamide dose.
Main Results:
- Oral mesna administration showed less variable excretion rates and amounts compared to intravenous.
- No cases of macrohematuria were observed in any of the 60 patients.
- Pharmacokinetic data supported the absorption and efficacy of oral mesna.
Conclusions:
- A combined intravenous and oral mesna regimen is effective in preventing hemorrhagic cystitis.
- This simplified regimen enhances convenience for outpatient ifosfamide administration.
- The study supports the use of oral mesna to improve patient compliance and treatment accessibility.