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14 DAY CONTINUOUS INFUSION HIGH-DOSE IFOSFAMIDE IN ADOLESCENT AND ADULT SARCOMA PATIENTS Andrew Hendifar , Shelly Chawla , Sandeep Nagre , Vicky Chua, Lita Fernandez, Bartosz Chmielowski , James Hu, and Sant Chawla Sarcoma Oncology Center, Santa Monica, CA
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14 DAY CONTINUOUS INFUSION HIGH-DOSE IFOSFAMIDE IN ADOLESCENT AND ADULT SARCOMA PATIENTS Andrew Hendifar, Shelly Chawla, SandeepNagre, Vicky Chua, Lita Fernandez, BartoszChmielowski, James Hu, and SantChawla Sarcoma Oncology Center, Santa Monica, CA University of Southern California, Division of Oncology, Los Angeles, CA UCLA Sarcoma Program, Medical Oncology, Los Angeles, CA lightheadedness and watery diarrhea. TSH was again less than 0.01, and ACTH less than 5. AST and ALT were 240 and 150, respectively, elevated from 71 and Introduction Results 11/2010 10/2011 All except one patient (alveolar soft part sarcoma) were pretreated with up to 7 chemotherapeutic regimens (median, 3 regimens). There were 11 responses (CR+PR 11/24, 46%) to date with a disease control rate (CR+PR+SD) of 75%. The regimen was well tolerated. No renal or bladder toxicity was noted. There were 2 occurrences of grade 3 neurotoxicity and 1 grade 3 hepatotoxicity in a single patient with diffuse liver metastases and low baseline albumin. There were 2 incidences of neutropenic fever in over 70 cycles of therapy. Continuous infusion high dose ifosfamide has shown efficacy and tolerability in pediatric patients with sarcoma. In the adult population, retrospective series demonstrate promise in patients and even in patients previously treated with ifosfamide. We studied this regimen in adult and adolescent patients with bone and soft tissue sarcomas. Methods Ifosfamide 1 g/m2/day with equivalent doses of mesna was given continuously by ambulatory infusion pump over 14 days. This regimen was prescribed every 28 days with growth factor support. 27 consecutive patients with measurable disease were enrolled from 08/25/10 until 08/15/11. 24 of the 27 patients studied were assessable for response (Recist 1.1). Our cohort included the following histologies: leiomyosarcoma (24%), liposarcoma (12%), osteosarcoma (12%) and vascular tumors (12%). Median age was 45 years with a range between 12 and 66 years of age. CT abdomen 3/3/06 46 yo woman with recurrent uterine LMS and metastases to liver and mesentery. Progressed through Adriamycin, Dacarbazine, Gemcitabine, Docetaxel, and Trabectedin. Received 11 cycles and plan for liver and mesenteric resection. Discussion 08/2010 Continuous infusion high dose ifosfamide at 1gm/m2/day over 14 days is highly active and well tolerated in a heavily pretreated cohort. We have confirmed reports of activity in patients previously treated with ifosfamide. A comparative effectiveness study is warranted to compare cost/benefit and patient preference between 14 day and 7 day regimens. 26 yo woman with locally recurrent synovial cell cancer after neoadjuvant and adjuvant ifosfamide and adriamycin. After 8 cycles of Ifosfamide was sent for re-resection. Pathology demonstrated 90% necrosis 05/2011