Doxorubicin and ifosfamide chemotherapy
Doxorubicin and ifosfamide chemotherapy is a treatment used to treat soft tissue sarcomas. You might hear people call the treatment AI after the drugs that are used (doxorubicin was originally called adriamycin). Other names for it include Dox-Ifos and I-Ad.
This information should ideally be read with our general information about chemotherapy and your type of cancer.
The drugs used in this treatment are:
How treatment is given
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Doxorubicin and ifosfamide chemotherapy is usually given to you during a short stay in hospital. Some people may have it as an outpatient and come in to the chemotherapy unit every day for their treatment.
A chemotherapy nurse will give you your treatment. During treatment, you will see a cancer doctor, a chemotherapy nurse or a specialist nurse. This is who we mean when we mention doctor or nurse in this information.
Before or on the day of treatment, a nurse or person trained to take blood (phlebotomist) will take a blood sample from you. This is to check that it is okay for you to have chemotherapy. You will also see a doctor or nurse before you have chemotherapy. They will ask you about how you have been. If your blood results are alright on the day of your treatment, the pharmacist will prepare your chemotherapy. Your nurse will tell you when your treatment is likely to be ready.
Your nurse gives you anti-sickness drugs as an injection into a vein or as tablets. They give you the anti-sickness drugs and chemotherapy through one of the following:
a fine tube that goes under the skin of your chest and into a vein close by (central line)
a fine tube that is put into a vein in your arm and goes up into a vein in your chest (PICC line)
a short thin tube (cannula) that the nurse puts into a vein in your arm or hand.
Your nurse will give you the doxorubicin (a red fluid) as an injection into your line or cannula with a drip to flush it through. Or, you may have doxorubicin given through a drip (infusion). The nurse will give you ifosfamide as a drip. They will run your drip through a pump, which gives you the treatment over a set time.
You will also be given fluids through a drip, and a drug called mesna (Uromitexan ®) as a drip and/or tablets. This helps to prevent bladder irritation, which is caused by ifosfamide.
When the chemotherapy is being given
Some people might have the following side effects while the chemotherapy is being given.
You may suddenly feel warm and your face may get red while doxorubicin is being given. This should only last a few minutes.
The drug leaks outside the vein
If this happens when you’re having doxorubicin, it can damage the tissue around the vein. This is called extravasation. Tell the nurse straight away if you have any stinging, pain, redness or swelling around the vein. Extravasation is rare, but if it happens it’s important that it’s dealt with quickly.
If you get any of these symptoms after you get home, contact the doctor or nurse straight away on the number they gave you.
Your course of doxorubicin and ifosfamide
You have chemotherapy as a course of several sessions (or cycles) of treatment over a few months. Each cycle of doxorubicin and ifosfamide takes 21 days (three weeks).
At the end of the 21 days, you start your second cycle. This is exactly the same as the first cycle. You may have 4-6 cycles given over 3-4 months. Your doctor or nurse will tell you how many cycles you are likely to have.
Ifosfamide and doxorubicin can be given in different ways. Your doctor or nurse will explain how you will have it.
You stay in hospital for this treatment. You have it over three days. On the first day, your nurse will give you a drip (infusion) of ifosfamide, which lasts 72 hours (three days). You’ll also have a drip of mesna for the same length of time. You will have doxorubicin once a day for three days. You can go home when your treatment is finished. You then have no chemotherapy for the next 18 days.
You can come into the chemotherapy day unit to have this treatment and then go home again. You have it over three days.
On the first day, your nurse will give you the doxorubicin and then a drip (infusion) of ifosfamide for four hours. You have mesna as tablets. You’ll have the same treatment repeated over the next two days. After this, you have no chemotherapy for the next 18 days.
You need to stay in hospital overnight for this treatment. You have it over one day. On the first day, your nurse will give you the doxorubicin and an injection of mesna. You then have a drip (infusion) of ifosfamide for 24 hours along with a mesna drip for the same length of time. You go home when it’s finished. You then have no chemotherapy for the next 20 days.
Before you go home, the nurse or pharmacist will also give you anti-sickness drugs to take. You may also have mesna tablets to take. Take all your tablets exactly as they have been explained to you.
We explain the most common side effects of doxorubicin and ifosfamide here. But we don’t include all the rare ones that are unlikely to affect you.
You may get some of the side effects we mention, but you are very unlikely to get all of them. Always tell your doctor or nurse about the side effects you have. Your doctor can prescribe drugs to help control some of these.
It is very important to take the drugs exactly as your nurse or pharmacist has explained. This means they will be more likely to work better. Your nurse will give you advice about managing your side effects. After your treatment is over, the side effects will start to improve.
Contact the hospital
Your nurse will give you telephone numbers for the hospital. You can call them if you feel unwell or need advice any time of day or night. Save these numbers in your phone or keep them somewhere safe.
Chemotherapy can reduce the number of white blood cells in your blood. This will make you more likely to get an infection. When the number of white blood cells is low, it’s called neutropenia.
Contact the hospital straight away on the contact number you’ve been given if:
your temperature goes over 37.5°C (99.5°F) or over 38°C (100.4°F), depending on the advice given by your chemotherapy team
you suddenly feel unwell, even with a normal temperature
you have symptoms of an infection – this can include feeling shaky, a sore throat, a cough, diarrhoea or needing to pass urine a lot.
The number of white blood cells usually increases steadily and returns to normal before your next treatment. You will have a blood test before having more chemotherapy. If your white blood cells are still low, your doctor may delay your treatment for a short time.
Your nurse may give you injections of a drug called GCSF under the skin. It encourages the bone marrow (where blood cells are made) to make more white blood cells.
Bruising and bleeding
This treatment can reduce the number of platelets in your blood. Platelets are cells that help the blood to clot. Tell your doctor if you have any bruising or bleeding that you can’t explain. This includes nosebleeds, bleeding gums, blood spots or rashes on the skin. Some people may need a drip to give them extra platelets.
Anaemia (low number of red blood cells)
This treatment can reduce the number of red blood cells in your blood. These cells carry oxygen around the body. If the number of red blood cells is low, you may be tired and breathless. Tell your doctor or nurse if you feel like this. If you are very anaemic, you may need a drip to give you extra red blood cells (blood transfusion).
This may happen in the first few days after chemotherapy. Your doctor will prescribe anti-sickness (anti-emetic) drugs to help prevent or control sickness. They may also give you a steroid drug to help. Take the drugs exactly as your nurse or pharmacist explained to you. It’s easier to prevent sickness than to treat it after it has started.
If you still feel sick or vomit twice or more in 24 hours, contact the hospital on the numbers they gave you as soon as possible. They will give you advice and may change the anti-sickness drug to one that works better for you.
Some anti-sickness drugs can make you constipated. Tell your doctor or nurse if this is a problem.
Feeling very tired is a common side effect. It’s often worse towards the end of treatment and for some weeks after it’s finished. Try to pace yourself and get as much rest as you need. It helps to balance this with some gentle exercise, such as short walks. If you feel sleepy, don’t drive or operate machinery. We have more information about coping with fatigue.
Your mouth may become sore and you may get ulcers. This can make you more likely to get an infection in your mouth. Gently clean your teeth and/or dentures morning and night and after meals. Use a soft-bristled or children’s toothbrush. Your nurse might ask you to rinse your mouth regularly or use mouthwashes. It’s important to follow any advice you are given and to drink plenty of fluids.
Tell your nurse or doctor if you have any problems with your mouth. They can prescribe medicines to prevent or treat mouth infections and reduce any soreness.
You usually lose all the hair on your head. Your eyelashes, eyelashes, eyebrows and other body hair may also thin or fall out. This usually starts after your first or second cycle of chemotherapy. It is almost always temporary and your hair will grow back after chemotherapy ends. It is important to cover your head to protect your scalp when you are out in the sun until your hair grows back. Your nurse can give you advice about coping with hair loss.
Your doctor can prescribe drugs to control diarrhoea. Let them know if it is severe or if it doesn’t get better. Make sure you drink at least two litres (three and a half pints) of fluids every day if you have diarrhoea.
Ifosfamide may irritate your bladder and cause discomfort when you pass urine. Drink plenty of fluids. You should try to drink at least two litres (three and a half pints) during the 24 hours following chemotherapy. It is also important to empty your bladder regularly and to try to pass urine as soon as you feel the need to go.
If you have been given mesna tablets to take, make sure you take them all. Mesna helps to prevent bladder irritation. Tell your nurse or doctor straight away if you feel any discomfort or stinging when you pass urine or if you notice any blood in your urine.
Your urine may be a pink-red colour for up to 48 hours after you’ve had your treatment. This is due to the colour of doxorubicin.
Chemotherapy may affect your skin. Your doctor or nurse can tell you what to expect. If your skin feels dry, try using an unperfumed moisturising cream every day. Ifosfamide can cause a rash, which may be itchy. Always tell your doctor or nurse about any skin changes. They can give you advice and may prescribe creams or medicines to help. Any changes to your skin are usually temporary and improve when treatment finishes.
During treatment and for several months afterwards, you'll be more sensitive to the sun and your skin may burn more easily than usual. You can still go out in the sun, but use a suncream with a sun protection factor (SPF) of at least 30, and cover up with clothing and a hat. Your skin may darken. It will return to its normal colour after you finish treatment.
The treated area may become red or sore if you’ve had radiotherapy recently or in the past.
Your nails may become brittle and break easily. They may get darker or discoloured, and/or you may get lines or ridges on them. These changes grow out after treatment finishes. Wearing gloves when washing dishes or using detergents will help protect your nails during treatment.
Your eyes may become watery and feel sore. Your doctor can prescribe eye drops to help with this. If your eyes get red and inflamed (conjunctivitis), tell your doctor. This is because you may need antibiotic eye drops.
Ifosfamide can cause changes in the way your liver works. These will usually go back to normal after treatment finishes. You will have regular blood tests to check how well your liver is working.
Less common side effects
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Effects on the nervous system
Rarely, ifosfamide can affect the nervous system. You may feel drowsy or confused, dizzy or unsteady. Tell your doctor or nurse straight away if you notice any of these symptoms. It’s important not to drive or operate machinery if you notice these effects.
Changes in the way the heart works
Doxorubicin can affect the way the heart works. You may have tests to see how well your heart is working before, during and sometimes after treatment.
If you have pain or tightness in your chest, feel breathless or notice changes to your heartbeat at any time during or after treatment, tell a doctor straight away. These symptoms can be caused by other conditions but it’s important to get them checked by a doctor.
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.
Blood clot risk
Cancer increases the chance of a blood clot (thrombosis) and chemotherapy can add to this. A clot can cause symptoms such as pain, redness and swelling in a leg, breathlessness and chest pain. Contact your doctor straight away if you have any of these symptoms. A blood clot is serious but your doctor can treat it with drugs that thin the blood. Your doctor or nurse can give you more information.
Some medicines can interact with chemotherapy or be harmful when you are having chemotherapy. This includes medicines you can buy in a shop or chemist. Tell your doctor about any medicines you are taking, including over-the-counter drugs, complementary therapies and herbal drugs.
Chemotherapy may affect your fertility (being able to get pregnant or father a child). If you are worried about this, you can talk to your doctor or nurse before treatment starts.
Your doctor will advise you not to become pregnant or to father a child during treatment. This is because the drugs may harm a developing baby. It’s important to use effective contraception during and for a few months after chemotherapy. You can talk to your doctor or nurse about this.
If you have sex within the first couple of days of having chemotherapy you need to use a condom. This is to protect your partner in case there is any chemotherapy in semen or vaginal fluid.
Changes to your periods
Chemotherapy can sometimes stop the ovaries working. You may not get a period every month and they may eventually stop. In some women, this is temporary but for others it is permanent and they start the menopause.
Women are advised not to breastfeed during treatment and for a few months after. This is in case there is chemotherapy in their breast milk.
Medical and dental treatment
If you need to go into hospital for any reason other than cancer, always tell the doctors and nurses that you are having chemotherapy. Explain you are taking chemotherapy tablets that no one should stop or restart without advice from your cancer doctor. Give them contact details for your cancer doctor.
Talk to your cancer doctor or nurse if you think you need dental treatment. Always tell your dentist you are having chemotherapy.
This section has been compiled using a number of reliable sources including:
electronic Medicines Compendium (eMC). medicines.org.uk accessed July 2013).
Perry MC. The Chemotherapy Source Book. 5th edition. 2012. Lippincott Williams and Wilkins.
With thanks to Christine Clarke, Lead Pharmacist Oncology and Haematology, who reviewed this edition.
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