Abstract 79P
Background
Ifosfamide (IFO) is one of the leading chemotherapy drugs used for advanced soft tissue (STS) and bone sarcomas (BS) treatment. It can induce several metabolic encephalopathy scenarios with different toxicities grading. This toxicity involves complex patients (pts) management including the use of methylene blue (MB).
Methods
This retrospective analyses consisted of pts with STS and BS treated with IFO (dose range: 9-15 g/mq) in neoadjuvant (neoadj), adjuvant (adj) or palliative setting from 2010 to 2022 at Regina Elena National Cancer Institute in Rome, an EURACAN sarcoma referral centre.
Results
We are presenting the preliminary data collected in the last two months on 72 pts treated with IFO. Pts characteristics were: male/female: 38 (53%)/34 (47%); median age: 48 yr (range 14-76); STS 61 (85%) (19 (31%) liposarcomas; 18 (30%) undifferentiated pleomorphic sarcomas; 8 (13%) synovial sarcomas; 5 (8%) myxofibrosarcomas; 11 (18%) other histotypes); BS 11 (15%). IFO was administered in: 41 pts (57%) in neoadj; 15 pts (21%) in adj; 16 pts (22%) in palliative setting. Seventeen out of 72 (24%) pts reported neurotoxicity: 12 (71%) after I cycle and 5 (29%) after II cycle. Twelve out of 17 pts (71%) developed G1-G2 neurotoxicity showing somnolence, headache, dizziness, confusion, paresthesia and peripheral motor neuropathy. Ten pts (59%) had G3-G4 neurotoxicity: panic attack, spasticity, emotional lability, space/time disorientation, cerebrovascular ischemia, hallucinations. Six pts (35%) with G3-4 toxicity required treatment with MB (50 mg iv every 4 hours) with complete symptom resolution. Premedication with MB (50 mg iv every 6 hours) were administered in 4 pts (24%) during the subsequent cycles. Of all 17 pts, 5 (29%) and 4 (24%) pts discontinued IFO temporarily and definitely respectively; 4 pts (24%) continued chemotherapy with a dose reduction. In neoadj/adj setting 51 pts (71%) were able to receive the planned courses of IFO.
Conclusions
Research predictors of IFO neurotoxicity is challenging and needed to better understand its etiopathogenesis. Collaboration with neurologists and psychologists could improve pts care. Complete analyses of all data collected are still ongoing to highlight toxicity management.
Clinical trial identification
Editorial acknowledgement
Legal entity responsible for the study
The authors.
Funding
Has not received any funding.
Disclosure
V. Ferraresi: Financial Interests, Personal, Invited Speaker: PharmaMar. All other authors have declared no conflicts of interest.