Ifosfamide is another active agent that has been investigated in the treatment of germ cell cancer. An initial prospective evaluation of single-agent ifos-famide for patients with refractory germ cell tumors who had received prior cisplatin was reported by Scheulen and colleagues.34 A confirmatory study was conducted at Indiana University.35 In this phase II trial, ifosfamide at 2 g/m2/d for 5 consecutive days every 3 weeks was administered to a heavily pre-treated poor-prognosis population. (Twenty-eight of 30 patients received ifosfamide as third-line or further therapy after the failure of at least two previous cisplatin-based regimens; 7 patients had extrago-nadal primaries.) Seven objective responses, including one complete remission, were reported. Of the 7 responders, 1 patient had a primary retroperitoneal germ cell tumor, 3 were cisplatin refractory, and 2 were refractory to etoposide, having progressed dur ing or within 1 month of treatment with these agents. None of these responses was durable, and the median response duration was 3.5 months.

Overall, of patients previously treated with cisplatin, single-agent ifosfamide produces responses in 20% and produces complete responses in 1%.35-37 The subsequent success of ifosfamide in multiagent salvage regimens suggests that a 20% response rate in cisplatin-refractory patients denotes an important level of activity.

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