Excretion kinetics of ifosfamide side-chain metabolites in children on continuous and short-term infusion

Int J Clin Pharmacol Ther. 1998 May;36(5):246-52.

Abstract

Ifosfamide (IFO) requires metabolic activation by hydroxylation of the ring system to exert cytotoxic activity. A second metabolic pathway produces the cytostatically inactive metabolites 2-dechloroethyl-ifosfamide (2-D-IFO) and 3-dechloroethyl-ifosfamide (3-D-IFO) under release of chloroacetaldehyde. This side-chain metabolism has been suggested to be involved in CNS- and renal toxicity. The total urinary excretion of ifosfamide and its metabolites was investigated during 23 cycles in 22 children at doses ranging from 400 mg/m2 to 3 g/m2. The kinetics of the excretion were compared following short-term and continuous ifosfamide infusion at a dosage of 3 g/m2. IFO and side-chain metabolites were analyzed by gas chromatography, the active metabolites by indirect determination of acrolein (ACR) and IFO mustard (IFO-M) with the NBP test. 59+/-15% of the applied dose could be recovered in the urine, 23+/-9% as unmetabolized IFO. The main metabolite was 3-D-IFO (14+/-4%) followed by isophosphoramide mustard (IFO-M) (13+/-4%) and 2-D-IFO (8+/-3%). Neither the total amount recovered nor the excretion kinetics of ifosfamide and side-chain metabolites showed obvious schedule dependency. The excretion kinetics of side-chain metabolites as well as unmetabolized IFO were nearly superimposable on short-term and continuous infusion. Even after 1-hour infusion there was a lag of 3 - 6 hours until dechloroethylation became relevant. Therefore, differences in toxicity and efficacy cannot be explained by an influence of the application time on the metabolic profile of ifosfamide.

MeSH terms

  • Acetaldehyde / analogs & derivatives
  • Acetaldehyde / urine
  • Acrolein / urine
  • Adolescent
  • Adult
  • Antineoplastic Agents, Alkylating / therapeutic use*
  • Antineoplastic Agents, Alkylating / urine
  • Child
  • Female
  • Humans
  • Ifosfamide / administration & dosage
  • Ifosfamide / analogs & derivatives
  • Ifosfamide / therapeutic use*
  • Ifosfamide / urine
  • Infusions, Intravenous
  • Kidney / drug effects
  • Male
  • Neoplasms / drug therapy*
  • Phosphoramide Mustards / urine

Substances

  • Antineoplastic Agents, Alkylating
  • Phosphoramide Mustards
  • isophosphamide mustard
  • Acrolein
  • chloroacetaldehyde
  • Acetaldehyde
  • Ifosfamide