Cyclophosphamide is alkylating agent used in the treatment of various solid tumors. Mucosal irritation by acrolein, the metabolite of cyclophosphamide, is believed to cause various symptoms of cystitis. The thiol compound, sodium 2-mercaptoethane sulfonate (Mesna), has been found to inactivate acrolein. We present an unusual case of a 64-year-old woman, who was treated as chronic cystitis. Her symptoms did not improve, so she was treated with Mesna under the assumption of cyclophosphamide induced cystitis; her symptoms then improved.
Acrolein ; Cyclophosphamide* ; Cystitis* ; Female ; Humans ; Mesna* ; Middle Aged ; Sodium

STUDY DESIGN: Authors experienced three cases of malignant schwannoma arising from multiple neurofibromatosis and invading the vertebrae. OBJECTIVE: To report treatment results and preventive idea in three cases of malignant schwannoma transformed from neurofibromatosis within the retroperifoneal area and invading the vertebrae. SUMMARY OF BACKGROUND DATA: The patients with neurofibromatosis are clearly at increased risk to develop the malignant schwannoma. A review of Korean literature revealed no such cases. RESULTS: The first case presented in the L4 body and was treated by surgical excision and chemotherapy, but she expired due to secondary metastasis in six months after diagnosis. The second case was treated by diagnostic biopsy and chemotherapy with adriamycin, ifosfamide, DTIC, mesna. He eventually lived for 14 months. After a diagnostic biopsy, the third case died due to lung metastasis before we could begin the treatment. CONCLUSION: We recommend that neurofibromatsis patients be regularly followed-up and if necessary, CT examination of spine or abdomen should be done. If a malignant schwannoma is detected, then early treatment can be started.
Abdomen ; Biopsy ; Dacarbazine ; Diagnosis ; Doxorubicin ; Drug Therapy ; Humans ; Ifosfamide ; Lung ; Mesna ; Neoplasm Metastasis ; Neurilemmoma* ; Neurofibromatoses ; Spine*

This phase II study aimed to assess the clinical activity and toxicity of ifosfamide based regimen in patients with epithelial ovarian cancer, relapsed or refractory to cisplatin-containing combination chemotherapy. From July 1991 to June 1993, 18 patients with epithelial ovarian cancer, relapsed or refractory to cisplatin were treated as follows. Relapsed cases were treated with IP(ifosfamide 4,0g/m2 intravenously and cisplatin 60mg/m2 intravenously on day 1) regimen every 3-4 weeks. The regimen used in refractory cases was Et-I(etoposide 100mg/m2 intravenously on days 1 to 3 and ifosfamide 1.0g/m2 intravenously on days 1 to 5) regimen every 3 or 4 weeks. The uroprotectant mesna was concomitantly used. Responses and toxicities were evaluated according to the WHO Criteria. The overall response rate was 27.8%(5/18), including 2 complete response and 3 partial response. There were four episodes(22.2%) of grade 3, 4 myelosuppression, but no other grade 3, 4 non-hematologic toxicity. Salvage therapy with ifosfamide based regimen is a useful and well tolerated treatment strategy in selected patients with relapsed ovarian cancer.
Cisplatin ; Drug Therapy, Combination ; Humans ; Ifosfamide ; Mesna ; Ovarian Neoplasms* ; Recurrence ; Salvage Therapy

Endometrial stromal sarcoma (ESS) that arises from extrauterine endometriosis is a rare form of malignancy. We report the case of a 37-year-old ESS patient with extrauterine endometriosis who was treated with ifosfamide/cisplatin chemotherapy. A woman presented with epigastric pain and abdominal distension. Computed tomography imaging revealed a profuse amount of ascites, including a 12.4x12.3 cm sized posterior cul-de-sac mass composed of solid and cystic components. Cytoreductive surgery was performed to remove the mass and the histopathologic findings indicated ESS associated with extrauterine endometriosis. Six cycles of combination chemotherapy [ifosfamide (5 g/m(2)) with mesna (1 g/m(2)) and cisplatin (50 mg/m(2)) (IP)] were administered. After a six-month of disease-free interval, recurrent ESS developed in the pelvic cavity and in both lung fields. Megace medication decreased tumor marker CA-125 for six weeks. However, the patient expired sixteen months after the cytoreductive surgery. ESS associated with extrauterine endometriosis showed response to IP chemotherapy and megace.
Adult ; Ascites ; Cisplatin ; Drug Therapy, Combination ; Endometriosis ; Female ; Humans ; Lung ; Megestrol Acetate ; Mesna ; Sarcoma, Endometrial Stromal

A fixed drug eruption (FDE) is a cutaneous reaction caused by various drugs. Mesna is used to decrease urotoxic side effect of cyclophosphamide and there have been no previously reported cases in Korea for any adverse reactions to this drug. Herein, we report a case of a FDE caused by mesna. A 34-year-old woman presented with asymptomatic, brownish macules and patches on the face and back for the past 4 months. She had been treated for SLE with monthly pulses of intravenous cyclophosphamide and mesna for 6 months. She had experienced similar episodes after injection of mesna. The skin biopsy specimen taken from her showed vacuolar degeneration of the basal cell layer and perivascular lymphohistiocyte infiltration in the papillary dermis. We performed prick test, scratch patch test, and intradermal test with mesna and confirmed that a FDE was caused by this drug.
Adult ; Biopsy ; Cyclophosphamide ; Dermis ; Drug Eruptions ; Female ; Humans ; Intradermal Tests ; Korea ; Mesna ; Patch Tests ; Skin

Hemorrhagic cystitis is potentially life-threatening sequellae of chemotherapy using oxazaphosphorine alkylating agents (cyclophosphamide and ifosfamide). Mesna contains a sulfhydryl group that is believed to bind acrolein within the urinary collecting system and reduce the hemorrhagic cystitis without affecting the chemotherapeutic potential. To date, about thirty cases of hypersensitivity or allergic reactions of the delayed and urticarial type associated with mesna have been reported. We reported two patients with systemic lupus erythematosus who developed facial rash and flushing associated with mesna which imitate malar rash.
Acrolein ; Alkylating Agents ; Cyclophosphamide ; Cystitis ; Drug Therapy ; Exanthema* ; Flushing ; Humans ; Hypersensitivity* ; Lupus Erythematosus, Systemic ; Mesna*

BACKGROUND: To evaluate the efficacy and toxicity of combination chemotherapy using ifosfamide, cisplatin, and etoposide in patients with advanced non-small cell lung cancer(NSCLC). MATERIALS AND METHODS: Thirty-three patients with inoperable NSCLC(stage III b+IV) who had measurable diseases, and had not been treated with chemotherapeutic drugs, were enrolled in this study(from March 1995 to December 1996). The patients received ifosfamide(1500mg/m2/day, a full drop with Mesna on days 1-5), Cisplatin (80mg/m2/day infusion with a hydration on day 2), and Etoposide (100mg/m2/day infusion for 2 hours on days 1-3). The treatment was repeated every 4 weeks. RESULTS: Ten patients showed a partial responses (30.3%). The overall survival time of the responders was longer than that of the non-responders (median 55 vs 22 weeks, p=0.01). The toxicities of this treatment were tolerable. Grade 3 or 4 leukopenia was observed in 21%. There was 1 death related to febrile neutropenia. The non-hematologic toxicity was mild. The relative dose intensity given to the patients was 0.86 ifosfamide, 0.87 cisplatin, and 0.89 etoposide, showing an average dose intensity of 0.87. CONCLUSIONS: A combination regimen of ifosfamide, cisplatin, and etoposide is effective and tolerable for treating advanced non-small cell lung cancer.
Carcinoma, Non-Small-Cell Lung* ; Cisplatin* ; Drug Therapy ; Drug Therapy, Combination* ; Etoposide ; Febrile Neutropenia ; Humans ; Ifosfamide* ; Leukopenia ; Lung ; Mesna

PURPOSE: A prolonged administration of etoposide increases its effectiveness on the suggestion that pralonged maintenance of low levels is an important factor in determining its activity. Many studies have been tried to define the efficacy of combination of oral etoposide with other chemotherapeutic drugs such as cisplatin, 5-FU, and ifosfamide in patients with advanced non-small cell lung cancer (NSCLC). In this study, we evaluated the effectiveness and toxicities of combination chemotherapy of oral etoposide with intravenous cisplatin and ifosfamide in advanced NSCLC patients. MATERIALS AND METHODS: Thirty-three patients with inoperable NSCLC who had measurable diseases and had not been treated with chemotherapeutic drug, were enrolled in this study (from May 1995 to April 1998). Treatment consisted of intravenous cisplatin (20 mg/m(2)/day, Day 1-3) and ifosfamide (1,800 mg/m(2)/day, Days 1-3) with Mesna (1,100 mg/m(2)/day, Days 1-3), and oral etoposide (50 mg/m(2)/day, Days 4-17). This treatment was repeated every 4 weeks. Patients showing stable disease or a better response were continued on treatment with the range of one to nine cycles (medium: 3 cycles). All patients were evaluated for the response, survival, and toxicity of this combination chemotherapy. RESULTS: Eleven patients showed either complete responses [CR, 3 (9%)] or partial responses [PR, 8 (24%)]. The median number of treatment cycles were 5 (range, 3-9) for responders and 2 (range, 1-7) for non-responders. The responders had median response duration of 10 months and the overall survival of 12 months. The overall survival of responders were longer than that of non-responders (median 19 vs 5 months, p 0.0232). The toxicities of this treatment were tolerable without treatment related death. Limiting toxicities were myelosuppression and oral mucbsities, Grade 3 or 4 leukopenia and oral mucosities were observed in 34% and 9%, respectively. CONCLUSION: The combination of cisplatin, ifosfamide, and oral etoposide produced encouraging response rates and median survival duration in patients with response. Further study of this combination is warranted in comparison with standard cisplatin+etoposide regimen or intravenous etoposide, cisplatin and ifosfamide regimen.
Carcinoma, Non-Small-Cell Lung ; Cisplatin* ; Drug Therapy, Combination* ; Etoposide* ; Fluorouracil ; Humans ; Ifosfamide* ; Leukopenia ; Mesna ; Small Cell Lung Carcinoma*

PURPOSE: The combination of cisplatin and etoposide has been a common first line regimen for the treatment of small cell lung cancer (SCLC). The schedule dependence, and equal efficacy, of the oral and intravenous dosing of etoposide has led to prolonged administration of oral etoposide, which is known to produce an encouraging response in SCLC. To improve the efficacy of the cisplatin/etoposide combination, we administered oral etoposide, with added ifosfamide, which had significant single agent activity against SCLC. We conducted this study to evaluate the efficacy and toxicity of the cisplatin, ifosfamide and oral etoposide (PIE) combination in patients with extensive small cell lung cancer. MATERIALS AND METHODS: Twenty-five patients with histologically confirmed extensive small cell lung cancer were enrolled into this study between January 2000 and May 2002. They were treated with, cisplatin at 20 mg/ m2/day, ifosfamide 1.5 g/m2/day, with mesna (all given intravenously on Days 1~3), and oral etoposide 50 mg/m2 on days 4~17. This cycle was repeated every 4 weeks for up to 6 cycles. We evaluated the corresponding disease responses and toxicities. RESULTS: The patients' characteristics were as follows: median age 65 years (32~75), 19 males and 6 females. The performance stati were ECOG 0 in 3 patients, ECOG 1 in 12 and ECOG 2 in 10. Sixteen patients had a partial response, 2 had a stable disease and 4 had a progressive disease. Thus, the overall objective response rate was 72.7% (95% CI: 49.6~88.4%), with a median response duration of 7 months (95% CI: 3.5~10.5 months). Myelosuppression was the major observed toxicity. Grades III and IV neutropenia were observed in 42 (46.1%) of the 91 cycles. Significant non-hematological toxicities (>or=Grade III) were uncommon, with the exception of nausea and vomiting. CONCLUSION: The response rate to the combination of cisplatin, ifosfamide and oral etoposide was similar to that of other combination chemotherapy studies in patients with extensive disease small cell lung cancer. The toxicity of the regimen was considered acceptable.
Appointments and Schedules ; Cisplatin* ; Drug Therapy, Combination ; Etoposide* ; Female ; Humans ; Ifosfamide* ; Male ; Mesna ; Nausea ; Neutropenia ; Small Cell Lung Carcinoma* ; Vomiting

Central nervous system (CNS) toxicity has been reported in approximately 10-30% of patients receiving intravenous infusions of ifosfamide. Encephalopathy is a rare but serious CNS adverse reaction in these patients, and although usually transient and reversible, may cause persistent neurological dysfunction or death. Clinical features range from fatigue and confusion to coma and death. Although methylene blue can be used to treat ifosfamide-induced neurotoxicity, including encephalopathy, its mechanism of action remains poorly defined. We describe here two patients with recurrent epithelial ovarian cancer who experienced fatal encephalopathy following ifosfamide/mesna treatment.
Brain Diseases, Metabolic ; Central Nervous System ; Coma ; Fatigue ; Humans ; Ifosfamide ; Infusions, Intravenous ; Mesna ; Methylene Blue ; Neoplasms, Glandular and Epithelial ; Ovarian Neoplasms