Drug Formulary information is intended for use by healthcare professionals. It is not intended to be medical advice. Some of the information, including information about funding for cancer drugs, does not apply to all patients. Cancer treatment plans are unique to each patient. If you are a patient, please speak with your healthcare team to understand how this information applies to you.
Severe weather warning in your area. Please stay indoors and stay safe. Read more
regimen-monograph
ETOPIFOS
or Rhabdomyosarcoma
Adjuvant
Curative
| ifosfamide
(Round to nearest 25 mg) |
1800 mg /m² | IV | Days 1 to 5 |
| mesna
(Round to nearest 1 mg) |
360 mg /m² | IV | Days 1 to 5 (immediately prior to Ifosfamide infusions) |
| mesna
(Round to nearest 1 mg) |
720 mg /m² | PO | Days 1 to 5 ( 4 hrs and 8 hrs post ifosfamide infusions) |
| etoposide
(Round to nearest 1 mg) |
100 mg /m² | IV | Days 1 to 5 |
REPEAT EVERY 21 DAYS
For a usual total of 12 cycles, or until evidence of disease progression or limited by drug toxicity
Doses should be modified according to the protocol by which the patient is being treated. The following recommendations are in use at some centres.
Dosage with toxicity
Hematologic Toxicities: See Appendix 6 for general recommendations.
Hepatic Impairment
| Bilirubin |
Action
|
|
If Bilirubin 1-2 x ULN
|
REDUCE Etoposide to 50% dose
|
|
If Bilirubin 2-4x ULN
|
REDUCE Etoposide to 25% dose
|
|
If Bilirubin > 4 x ULN
|
STOP treatment with Etoposide
|
The dose of ifosfamide should be adjusted in the presence of hepatic impairment.
Renal Impairment
| Creatinine Clearance or Serum Creatinine |
Action
|
|
If CrCl 0.2–0.8 mL/sec
|
REDUCE Etoposide to 75% dose
|
|
If CrCl 0.5 mL/sec or Serum Creatinine > 185 µmol/L
|
REDUCE Ifosfamide to 75% of dose
|
|
If CrCl < 0.2mL/sec or Serum Creatinine > 300 µmol/L
|
REDUCE Ifosfamide to 67% of dose and
REDUCE Etoposide to 50% dose
|
Recommended Clinical Monitoring
- Clinical toxicity (including stomatitis, neurotoxicity, cystitis, local toxicity, cardiotoxicity) assessment.
- CBC before each cycle.
- Baseline and regular liver function tests.
- Baseline and regular renal function tests (including electrolytes and magnesium) and urinalysis.
- Grade toxicity using the current NCI-CTCAE (Common Terminology Criteria for Adverse Events) version
back to top
Miser JS, Kinsella TJ, Triche TJ, et al, Ifosfamide with mesna uroprotection and etoposide: an effective regimen in the treatment of recurrent sarcomas and other tumours of children and young adults J Clin Oncol, 1987; 5: 1191-1198
IFOS-ETOP: Sarcoma Systemic Treatment Record Summaries. Juravinski Cancer Centre, April 2008.
Sarcomas are rare tumours and as such benefit from referral to specialized centres where there will be access to multidisciplinary expertise including good radiology, orthopedic and thoracic surgery, medical oncology, radiation oncology, pathology, and other supportive care disciplines.
September 2011: regimen archived
Regimen Abstracts
A Regimen Abstract is an abbreviated version of a Regimen Monograph and contains only top level information on usage, dosing, schedule, cycle length and special notes (if available). It is intended for healthcare providers and is to be used for informational purposes only. It is not intended to constitute or be a substitute for medical advice, and all uses of the Regimen Abstract are subject to clinical judgment. Such information is provided on an “as-is” basis, without any representation, warranty, or condition, whether express, or implied, statutory or otherwise, as to the information’s quality, accuracy, currency, completeness, or reliability, and Cancer Care Ontario disclaims all liability for the use of this information, and for any claims, actions, demands or suits that arise from such use.
Information in regimen abstracts is accurate to the extent of the ST-QBP regimen master listings, and has not undergone the full review process of a regimen monograph. Full regimen monographs will be published for each ST-QBP regimen as they are developed.
Regimen Monographs
Refer to the New Drug Funding Program or Ontario Public Drug Programs websites for the most up-to-date public funding information.
The information set out in the drug monographs, regimen monographs, appendices and symptom management information (for health professionals) contained in the Drug Formulary (the "Formulary") is intended for healthcare providers and is to be used for informational purposes only. The information is not intended to cover all possible uses, directions, precautions, drug interactions or adverse effects of a particular drug, nor should it be construed to indicate that use of a particular drug is safe, appropriate or effective for a given condition. The information in the Formulary is not intended to constitute or be a substitute for medical advice and should not be relied upon in any such regard. All uses of the Formulary are subject to clinical judgment and actual prescribing patterns may not follow the information provided in the Formulary.
The format and content of the drug monographs, regimen monographs, appendices and symptom management information contained in the Formulary will change as they are reviewed and revised on a periodic basis. The date of last revision will be visible on each page of the monograph and regimen. Since standards of usage are constantly evolving, it is advised that the Formulary not be used as the sole source of information. It is strongly recommended that original references or product monograph be consulted prior to using a chemotherapy regimen for the first time.
Some Formulary documents, such as the medication information sheets, regimen information sheets and symptom management information (for patients), are intended for patients. Patients should always consult with their healthcare provider if they have questions regarding any information set out in the Formulary documents.
While care has been taken in the preparation of the information contained in the Formulary, such information is provided on an “as-is” basis, without any representation, warranty, or condition, whether express, or implied, statutory or otherwise, as to the information’s quality, accuracy, currency, completeness, or reliability.
CCO and the Formulary’s content providers shall have no liability, whether direct, indirect, consequential, contingent, special, or incidental, related to or arising from the information in the Formulary or its use thereof, whether based on breach of contract or tort (including negligence), and even if advised of the possibility thereof. Anyone using the information in the Formulary does so at his or her own risk, and by using such information, agrees to indemnify CCO and its content providers from any and all liability, loss, damages, costs and expenses (including legal fees and expenses) arising from such person’s use of the information in the Formulary.
Last Updated: July 21, 2026