Ifosfamide and Cyclophosphamide

Initial approaches to treatment of resistant or recurrent neuroblastoma in the previous decade concentrated on use of more intensive combination therapy or use of newer platinum or alkylating agents. Neu-roblastoma was proven to be responsive to ifosfamide alone (Castleberry et al. 1994; Pratt 1992; Kellie et al. 1988), and then to combinations of ifosfamide with etoposide (Watts 1992; Kung et al. 1993) or with car-boplatin with or without etoposide (Goorin et al. 1995; Alvarado et al. 1997) or with continuous infusion doxorubicin, cisplatin, and etoposide (Campbell et al. 1993; Fernandez et al. 2000). These studies resulted in the incorporation of ifosfamide subsequently into multiple induction regimens (Pinkerton et al. 1990; Olgun et al. 2003; Grupp et al. 2000). Since exposure to alkylating agents at high doses is now widely used in both induction and consolidation regimens for neuroblastoma, and since many patients may already have impairment of renal function due to surgery and prior cisplatin,ifosfamide may be currently less useful than cyclophosphamide as a treatment of relapse.

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