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This information is about a chemotherapy| treatment for soft tissue sarcomas| called doxorubicin and ifosfamide.
The treatment involves two chemotherapy drugs: doxorubicin| and ifosfamide|.
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 – either 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 shouldn't 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 the crook of 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:
Ifosfamide can irritate the bladder lining| and cause bleeding. To counteract this you will be given infusions of salt water (saline) and a drug called mesna| (Uromitexan®). Mesna can be given as an infusion connected to your cannula or line, or as an injection into the line. It's usually given before, during, and after the ifosfamide is given. Sometimes mesna may be given as tablets instead, which you can take at home. It's very important that you take the tablets exactly as you have been told.
Once your treatment finishes you can usually go home, and the cannula will be removed before you go. If you have a central or PICC line it will usually stay in place, ready for the next cycle of your chemotherapy. You will be shown how to look after the line.
Before you go home you'll be given a supply of anti-sickness drugs to take with you. It is important to take these regularly as directed, even if you aren't feeling sick. This is because some anti-sickness drugs are much better at preventing sickness than stopping it once it starts.
Your doctor may use the word 'regimen|' (eg doxorubicin and ifosfamide regimen) when talking about your chemotherapy. This means the whole plan or schedule of the particular treatment you are receiving.
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, 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'll start an infusion of ifosfamide that lasts for 72 hours (three days). You'll also be given the doxorubicin. The doxorubicin is repeated on day two and again on day three. At the same time as the ifosfamide you'll also be given a 72 hour infusion of mesna. You'll 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. Each cycle takes 21 days (three weeks).
On day one of the treatment you'll 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. Each cycle takes 21 days (three weeks).
For this schedule you'll 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 be given mesna as an injection before the ifosfamide and also as a 24-hour infusion alongside the ifosfamide infusion. Once the ifosfamide and mesna have finished you can go home. After this you'll have a rest period with no treatment for the next three weeks.
This completes a cycle of your treatment.
After your 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 experience more. The side effects described here won't affect everyone who has doxorubicin and ifosfamide chemotherapy.
We have outlined the most common side effects but haven't included those that are rare and unlikely to affect you. If you notice any effects that aren't listed here, discuss them with your doctor, chemotherapy nurse or pharmacist.
Doxorubicin and ifosfamide can reduce the number of white blood cells, which help to fight infection. White blood cells are produced by the bone marrow|. If the number of your white blood cells is low you will be more prone to infections|. A low white blood cell count is called neutropenia.
Neutropenia begins seven days after treatment and your resistance to infection is usually at its lowest 10–14 days after chemotherapy. The number of your white blood cells will then increase steadily and usually return to normal before your next cycle of chemotherapy is due.
You'll have a blood test before having more chemotherapy to check the number of white blood cells. Occasionally, your treatment may need to be delayed if your number of blood cells (blood count) is still low.
You may be given injections of G-CSF| 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. G-CSF is given as an injection under the skin (subcutaneously).
Doxorubicin and ifosfamide can reduce the production of platelets, which help the blood to clot. Tell your doctor if you have any unexplained bruising or bleeding, such as nosebleeds, bleeding gums, blood spots or rashes on the skin. You can have a platelet transfusion| if your platelet count is low.
Doxorubicin and ifosfamide can reduce the number of red blood cells, which carry oxygen around the body.
A low red blood cell count is called anaemia. This may make you feel tired and breathless|. Tell your doctor or nurse if you have these symptoms. You may need to have a blood transfusion| if the number of red blood cells becomes too low.
This may begin 2–3 hours after the treatment is given and can last for up to two weeks. Your doctor can prescribe very effective anti-sickness (anti-emetic) drugs to prevent or greatly reduce nausea and vomiting|. If the sickness isn't 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.
Feeling tired| is a common side effect of chemotherapy, especially towards the end of treatment and for some weeks after it’s over. It’s important to try to pace yourself and get as much rest as you need. Try to balance this with some gentle exercise, such as short walks, which will help. If tiredness is making you feel sleepy, don’t drive or operate machinery.
This usually starts 3–4 weeks after starting treatment, although it may occur earlier. Hair usually falls out completely. You may also have thinning and loss of eyelashes, eyebrows and other body hair|. This is temporary and your hair will start to grow again once the treatment has finished. Your hair may grow back straighter, curlier, finer, or a slightly different colour than it was before. Your nurse can give you advice about coping with hair loss|.
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. Some people may find sucking on ice soothing. Tell your nurse or doctor if you have any of these problems, as they can prescribe mouthwashes and medicine to prevent or clear mouth infections.
You may notice that food tastes different|. Normal taste usually comes back after treatment finishes. A dietitian or specialist nurse at your hospital can give you advice about ways of coping with this side effect.
Ifosfamide may irritate the bladder|. It’s important to drink as much fluid as you can (at least two litres a day) during the treatment. You’ll usually be given fluids through a drip (infusion), along with a drug called mesna (Uromitexan®) to help prevent bladder irritation. Your urine will be measured and tested for blood. If there’s any blood in your urine you’ll be given more mesna.
Your urine may become a pink-red colour. This is normal and is due to the colour of the doxorubicin. This may last up to 48 hours after you’ve had your treatment.
Ifosfamide can cause a rash or dry skin, which may be itchy. Your doctor can prescribe medicine to help with this. Areas of skin that have previously been treated with radiotherapy may become red and sore. Let your doctor know if this happens.
Rarely, your skin may darken. If it does, it usually goes back to normal a few months after the treatment has finished.
During treatment and for several months afterwards, you will be more sensitive to the sun and your skin may burn more easily than normal. You can still go out in the sun, but should wear a suncream with a high sun protection factor (SPF) and cover up with clothing and a hat.
The colour of your nails may change. They may become darker and white lines may appear on them. These usually grow out over several months once the treatment has finished.
Doxorubicin can cause diarrhoea. This can usually be easily controlled with medicine but tell your doctor if it is severe or continues. It's important to drink plenty of fluids if you have diarrhoea|.
These side effects are very rare and only occur with high-dose ifosfamide treatment. If you notice any of these effects it's important to tell your doctor straight away.
This is very rare with standard doses of doxorubicin, but may occasionally occur with high-dose treatment. The muscle of the heart may be affected, usually temporarily. Tests to see how well your heart is working may be carried out before the drug is given, and sometimes before each treatment.
Treatment with ifosfamide may cause changes in the way that your liver| works, although it will return to normal when the treatment finishes. You're very unlikely to notice any problems but your doctor will take regular blood samples to check your liver is working properly.
It’s important to let your doctor know straight away if you feel unwell or have any severe side effects, even if they’re not mentioned above.
If this happens when doxorubicin is being given, the tissue in that area can be damaged. Tell the doctor or nurse immediately if you notice any stinging or burning around the vein while the drug is being given. This is unlikely to happen if the chemotherapy is given through a central or PICC line.
If the area around the injection site becomes red or swollen at any time, you should tell the doctor or nurse on the ward. If you are at home, ring the clinic or ward and ask to speak to the doctor or nurse.
You may have a sudden feeling of warmth and some reddeningin your face. This can happen for a short period of time while doxorubicin is being given.
Cancer can increase the risk of developing a blood clot (thrombosis), and 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’s important to tell your doctor straight away if you notice any of these symptoms. Most clots can be treated with drugs that thin the blood. The doctor or nurse can give you more information.
Some medicines, including those that you can buy in a shop or chemist, can be harmful to take when you are having chemotherapy. Tell your doctor about any medicines you are taking, including over-the-counter drugs, complementary therapies| and herbal drugs|.
Your ability to become pregnant or father a child is likely to be affected by having this treatment. It's important to discuss fertility| with your doctor before starting treatment.
It's not advisable to become pregnant or father a child while having doxorubicin and ifosfamide, as it may harm the developing baby. It's important to use effective contraception while taking this drug, and for at least a few months afterwards. You can discuss this with your doctor or nurse.
It’s not known whether chemotherapy drugs can be present in semen or vaginal fluids. To protect your partner it’s safest to either avoid sex or use a barrier form of contraception for about 48 hours after chemotherapy.
Due to the effect of chemotherapy on the ovaries, women may find that their periods become irregular and they may eventually stop.
In some women this may be temporary, but for others it will be permanent. This will result in menopausal symptoms| such as hot flushes, sweats and vaginal dryness.
There's a potential risk that chemotherapy drugs may be present in breast milk. Women are advised not to breastfeed during chemotherapy and for a few months afterwards.
If you’re admitted to hospital for a reason not related to the cancer, it’s important to tell the doctors and nurses looking after you that you are having chemotherapy treatment. You should tell them the name of your cancer specialist so that they can ask for advice.
It’s a good idea to know who you should contact if you have any problems or troublesome side effects when you’re at home. Your chemotherapy nurse or doctor will give you details of who to contact for advice. This should include ‘out-of hours’ contact details if you need to call someone at evenings, overnight or at the weekend.
This section is based upon our doxorubicin and ifosfamide chemotherapy fact sheet, which has been compiled using information from a number of reliable sources including:
Content last reviewed: 1 December 2011
Next planned review: 2013
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If you have any questions about cancer, need support or just want someone to talk to, ask Macmillan.
Watch our slideshow with tips for coping with a poor appetite
Watch our slideshow with tips for coping with a sore mouth
Watch our video about coping with fatigue
Watch our slideshow about avoiding infection when you have reduced immunity
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