Main Article Content
Ifosfamide, whether in single or combination regimen, have been used in many centers for end-stage cervical cancer cases or recurrent cases. Although it has shown satisfying results, especially in cases of platinum resistance, this drug is related to various side effects, such as encephalopathy. In this study, several cases of acute encephalopathy in cervical cancer patients treated with ifosfamide chemotherapy are described. This study is a retrospective study using all cervical cancer cases receiving ifosfamide chemotherapy in Sanglah Hospital Denpasar from 2015 to 2017. The diagnosis of encephalopathy was established by neurologists. Data obtained from hospital medical records. There were five patients who received the second line ifosfamide-cisplatin chemotherapy regimen at Sanglah Hospital Denpasar from 2015 to 2017. They had received first-line chemotherapy in form of 6 series of paclitaxel carboplatin and some of them received additional therapy in the form of external radiation and brachytherapy. Ifosfamide-cisplatin chemotherapy was given from one to six series, depending on the patient's response. Side effects in the form of encephalopathy appeared in four patients, while one patient managed to recover. Ifosfamide encephalopathy is a side effect that needs to be monitored. It has varied symptoms, but the symptoms are generally mild. Analysis of patient risk factors, patient education, and preparation for the management of encephalopathy should be performed in all cases that will receive ifosfamide. Methylene blue and thiamine can be used as a prophylactic and therapeutic choice for this condition.
This work is licensed under a Creative Commons Attribution 4.0 International License.
- Nurcahyanti ADR. Cervical Cancer: The Case in Indonesia and Natural Product-Based Therapy. 2016:7.
- Buda A, Dell’Anna T, Signorelli M, Mangioni C. Role of Ifosfamide in Cervical Cancer: An Overview. Oncology. 2003;65(2):63-66. doi:10.1159/000073362.
- Livshits Z, Rao RB, Smith SW. An Approach to Chemotherapy-Associated Toxicity. Emerg Med Clin North Am. 2014;32(1):167-203. doi:10.1016/j.emc.2013.09.002.
- Kumar L, Gupta S. Integrating Chemotherapy in the Management of Cervical Cancer: A Critical Appraisal. Oncology. 2016;91(1):8-17. doi:10.1159/000447576.
- Tascilar M, Loos WJ, Seynaeve C, Verweij J, Sleijfer S. The Pharmacologic Basis of Ifosfamide Use in Adult Patients with Advanced Soft Tissue Sarcomas. The Oncologist. 2007;12(11):1351-1360. doi:10.1634/theoncologist.12-11-1351.
- Wagner T. Ifosfamide Clinical Pharmacokinetics: Clin Pharmacokinet. 1994;26(6):439-456. doi:10.2165/00003088-199426060-00003.
- Sleurs C, Deprez S, Emsell L, Lemiere J, Uyttebroeck A. Chemotherapy-induced neurotoxicity in pediatric solid non-CNS tumor patients: An update on current state of research and recommended future directions. Crit Rev Oncol Hematol. 2016;103:37-48. doi:10.1016/j.critrevonc.2016.05.001.
- Highley M, Momerency G, Sawyers D, Prenen H, Boeck G, Oosterom A, Mansi J, Blake P, Mant T, Maes R, Harper P. The Neurotoxicity and Pharmacokinetics of Oral Ifosfamide. J Anal Oncol. 2015;4(1):13-23. doi:10.6000/1927-7229.2015.04.01.3.
- Lo Y, Shen L-J, Chen W-H, Dong Y-H, Wu F-LL. Risk factors of ifosfamide-related encephalopathy in adult patients with cancer: A retrospective analysis. J Formos Med Assoc. 2016;115(9):744-751. doi:10.1016/j.jfma.2015.07.016.
- Ajithkumar TV, Minimole AL, John MM, Ashokkumar OS. Primary Fallopian Tube Carcinoma: Obstet Gynecol Surv. 2005;60(4):247-252. doi:10.1097/01.ogx.0000158506.23663.79.
- Alici-Evcimen Y, Breitbart WS. Ifosfamide neuropsychiatric toxicity in patients with cancer. Psychooncology. 2007;16(10):956-960. doi:10.1002/pon.1161.
- Patel PN. Methylene Blue for Management of Ifosfamide-Induced Encephalopathy. Ann Pharmacother. 2006;40(2):299-303. doi:10.1345/aph.1G114.
- Ginimuge PR, Jyothi SD. Methylene blue: revisited. J Anaesthesiol Clin Pharmacol. 2010;26(4):517-520.
- Giovanis P, Garna A, Marcante M, Nardi K, Giusto M. Ifosfamide encephalopathy and use of methylene blue. A case report of different sequential neurotoxicity. Tumori. 2009;95(4):545-546.
- Lin JK, Chow DS, Sheu L, Rehani B. Wernicke-Like Encephalopathy Associated With Ifosfamide. The Neurohospitalist. 2017;7(1):49-50. doi:10.1177/1941874416637407.