The role of ifosfamide in germ cell tumors and small cell lung cancer.

Ifosfamide has been found to have antineoplastic activity in a variety of solid tumors. In germ cell tumors, the substitution of ifosfamide for bleomycin in the standard combination bleomycin/etoposide/cisplatin (BEP) did not improve efficacy and caused significantly more toxicity than BEP. This regimen (VIP), however, has shown promise when used with high-dose carboplatin/etoposide as salvage therapy in patients with germ cell tumors not responding to first-line BEP. It is unclear whether the addition of ifosfamide to the carboplatin/etoposide regimen results in an improved therapeutic outcome in patients with multiple recurrent germ cell tumors. In such patients, as well as in those with poor-risk germ cell cancer, high-dose chemotherapy given with hematopoietic growth factors and bone marrow rescue may have a role. In small cell lung cancer, single-agent ifosfamide has produced response rates of 48% to 76%. Currently, the role of ifosfamide is being defined in untreated and recurrent small cell lung cancer.