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This information is about a chemotherapy treatment called doxorubicin and ifosfamide, which is used to treat particular types of cancer known as soft tissue sarcomas. It describes the drugs used, how they are given and some of the possible side effects. If you have any questions you can ask your doctor or nurse at the hospital where you are having your treatment, or speak to one of our cancer support service nurses.
The treatment involves two chemotherapy drugs:
You may sometimes hear this treatment being called AI after the drugs that are used (doxorubicin was originally called Adriamycin®). Other names for this treatment are Dox-Ifos and I-Ad.
Doxorubicin and ifosfamide chemotherapy is usually given to you during a short stay in hospital. Before you start treatment you will need to have a blood test on the same day or a few days beforehand. You will also be seen by a doctor, specialist nurse or pharmacist. If the results of your blood test are normal, the pharmacy will prepare your chemotherapy drugs. All of this may take a couple of hours.
The nurse will then put a thin, flexible tube (cannula) into a vein in your hand or arm. You may find this uncomfortable or a little painful, but it should not take long. Some people have their chemotherapy given through a thin plastic tube that is inserted under the skin into a vein near the collarbone (central line), or passed through a vein in their arm (PICC line). Your doctor or nurse will explain more about this to you.
You will either be given an anti-sickness (anti-emetic) drug as tablets or by injection through the cannula, your central line or PICC line. The chemotherapy drugs are then given separately:
Once your treatment is finished you can usually go home. The cannula will be removed and you will be given a supply of anti-sickness drugs to take with you. It is important to take these regularly as directed, even if you are not feeling sick. This is because some anti-sickness drugs are much better at preventing sickness than stopping it once it starts.
Doxorubicin and ifosfamide chemotherapy can be given in a number of different ways. They are all very similar and involve between one and three days of both ifosfamide and doxorubicin, along with mesna, which can be given by tablet or by infusion.
Your doctors will have decided which schedule they feel best suits the people that they treat. Often only one schedule will be used in each hospital.
Your doctor may use the word 'regimen' (for example, doxorubicin and ifosfamide regimen) when talking about your chemotherapy. This means the whole plan or schedule of the particular chemotherapy treatment that you are receiving. There are different ways of giving this regimen and your doctor, nurse or pharmacist will explain your schedule. Below are descriptions of three different schedules for giving doxorubicin and ifosfamide.
On the first day of treatment you will start an infusion of ifosfamide that lasts for 72 hours (three days). You will also be given the doxorubicin. The doxorubicin is repeated on day two and again on day three. You will be given the mesna as an infusion over 72 hours at the same time as the ifosfamide. You will need to stay in hospital for this treatment, but once the ifosfamide and mesna have finished you can go home. This is then followed by a rest period with no chemotherapy for the next 18 days. This completes what is called a cycle of your chemotherapy.
On day one of the treatment you will be given the doxorubicin and an infusion of ifosfamide that lasts for four hours. The mesna is given to you as tablets. The same treatment is repeated on the next day and again on day three. Having the treatment in this way allows you to be treated as an outpatient, only coming into hospital each day for the chemotherapy. Once the third lot of chemotherapy is given (on day three) there is a rest period with no treatment for 18 days. This completes one cycle of your chemotherapy.
For this schedule you will need to stay in hospital overnight. When your treatment begins you will be given doxorubicin and an infusion of ifosfamide that lasts for 24 hours. You will also be given mesna as an injection before the ifosfamide and also as a 24-hour infusion alongside the ifosfamide infusion. After this you will have a rest period with no treatment for the next three weeks. This completes a cycle of your treatment.
After the rest period the same treatment will be repeated again, beginning the next cycle of your treatment. Usually the cycles are repeated every three weeks, with 4–6 cycles given over a period of 3–4 months. This makes up a course of treatment. You can ask your doctor or nurse to explain which one you are having.
Each person's reaction to chemotherapy is different. Some people have very few side effects, while others may have more. The side effects described here will not affect everyone who is having doxorubicin and ifosfamide chemotherapy. We have outlined the most common side effects, so that you can be aware of them if they occur. However, we have not included those that are rare and therefore unlikely to affect you. If you notice any effects that you think may be due to the drugs, but which are not listed in this information, please let your nurse or doctor know.
Lowered resistance to infection Doxorubicin and ifosfamide can reduce the production of white blood cells by the bone marrow, making you more prone to infection. This effect can begin seven days after treatment has been given, with your resistance to infection usually reaching its lowest point 10–14 days after chemotherapy. Your blood cells will then increase steadily and will usually have returned to normal levels before your next cycle of chemotherapy is due.
Contact your doctor or the hospital straightaway if:
You will have a blood test before having more chemotherapy to make sure that your number of white blood cells has returned to normal. Occasionally, it may be necessary to delay treatment if your number of blood cells (blood count) is still low.
You may be given injections of G-CSF (granulocyte-colony stimulating factor) to help prevent the number of white blood cells getting too low. G-CSF is a type of protein that can stimulate the bone marrow to produce white blood cells. The injections are given under the skin (subcutaneously).
Bruising or bleeding This treatment can reduce the production of platelets (which help the blood to clot). Let your doctor know if you have any unexplained bruising or bleeding, such as nosebleeds, blood spots or rashes on the skin, or bleeding gums.
Anaemia (low number of red blood cells) While having chemotherapy you may become anaemic. This may make you feel tired and breathless. Let your doctor or nurse know if these are a problem.
Feeling sick (nausea) and being sick (vomiting) Your doctor can prescribe very effective anti-sickness (anti-emetic) drugs to prevent or reduce nausea and vomiting. If the sickness is not controlled, or if it continues, tell your doctor. They can prescribe other anti-sickness drugs that may be more effective. Some anti-sickness drugs can cause constipation. Let your doctor or nurse know if this is a problem.
Tiredness Many people feel extremely tired (fatigued) during chemotherapy, particularly towards the end of treatment. This is a very common side effect and it is important to try to get as much rest as you need.
Hair loss This usually starts 3–4 weeks after the first course of treatment. Hair usually falls out completely. You may also have thinning and loss of eyelashes, eyebrows and other body hair. Hair loss is temporary and your hair will start to grow again once the treatment has finished.
Sore mouth and ulcers Your mouth may become sore or dry, or you may notice small ulcers during this treatment. Drinking plenty of fluids and cleaning your teeth regularly and gently with a soft toothbrush can help to reduce the risk of this happening. Tell your nurse or doctor if you have any of these problems, as they can give you special mouthwashes and medicine to prevent or clear any mouth infection.
You may notice that your food tastes different. Normal taste will usually come back after the treatment finishes.
Irritation of the bladder Ifosfamide can irritate the bladder, so it is important to try to drink plenty of fluids (up to two litres a day if you can). You will be given fluids through a drip (infusion) and also the drug mesna to protect your bladder. Your urine will be measured and tested for the presence of blood. If blood is present, further doses of mesna will be given.
Doxorubicin may cause your urine to become a pink-red colour. This effect may last up to 24 hours after you have had the drug and is quite normal.
Skin changes Rarely, your skin may darken. If it does, it usually goes back to normal a few months after the treatment has finished. Ifosfamide can cause a rash that may be itchy and your doctor can prescribe medicine to help with this.
During treatment, and for several months afterwards, you will be more sensitive to the sun and your skin may burn more easily. You can still go out in the sun, but always wear a high protection-factor suncream and cover up with clothes.
Sometimes areas which have been treated with radiotherapy may become red and sore. Let your doctor know if this happens.
Changes in nails Your nails may become darker and ridged, or white lines may appear on them. These changes usually grow out over a few months once the treatment has finished.
Diarrhoea If you have diarrhoea, it can usually be easily controlled with medicine. Let your doctor know if it is severe or if it continues. Try to drink as much as 2–3 litres of fluid a day to replace the fluid you are losing.
Confusion, lethargy, sleepiness and loss of balance Rarely, these side effects may occur with ifosfamide. If you notice any of these, it is important to tell your doctor.
Changes in the way your heart works Higher doses of doxorubicin may cause changes in the muscle of the heart. This can affect how the heart works. Tests to see how well your heart is working may sometimes be carried out before the drug is given.
Always let your doctor or nurse know about any side effects that you have. There are usually ways in which they can be controlled or improved.
Risk of blood clots Cancer can increase your risk of developing a blood clot (thrombosis), and having chemotherapy may increase this risk further. A blood clot may cause symptoms such as pain, redness and swelling in a leg, or breathlessness and chest pain. Blood clots can be very serious, so it is important to tell your doctor straightaway if you have any of these symptoms. However, most clots can usually be successfully treated by using drugs which thin the blood. Your doctor or nurse can give you more information.
Other medicines Some other medicines can be harmful to take when you are having chemotherapy. Let your doctor know about any medications you are taking, including non-prescribed drugs such as complementary therapies and herbal drugs.
Leakage into the tissue around the vein If this happens while doxorubicin is being given, the tissue in that area can be damaged. If you notice any stinging or burning around the vein while the drug is being given, tell the doctor or nurse immediately.
Fertility Your ability to conceive or father a child is likely to be affected by this treatment. It is important to discuss fertility with your doctor before starting treatment.
Contraception It is not advisable to become pregnant or father a child while taking this treatment, as the developing foetus may be harmed. It is important to use effective contraception during treatment and for a few months afterwards. Again, discuss this with your doctor.
Loss of periods in women Due to the effect of chemotherapy on the ovaries you may find that your periods become irregular and may eventually stop. In younger women this may be temporary but if you are closer to your menopause it may be permanent. This will result in menopausal symptoms such as hot flushes, sweats and vaginal dryness.
This section is based upon our doxorubicin and ifosfamide chemotherapy factsheet which has been compiled using information from a number of reliable sources, including:
For further references, please see the general bibliography.
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