Doxifos (doxorubicin and ifosfamide)

Doxorubicin and ifosfamide is the name of a combination of chemotherapy drugs used to treat soft tissue sarcoma. It is sometimes called dox-ifos or Doxifos. It is made up of the drugs

• Doxorubicin (also known as Adriamycin)
• Ifosfamide

The links above take you to more information about the individual side effects of each of these drugs.

The side effects of a combination of drugs are usually a mixture of those of each drug. The combination may increase or decrease your chance of getting each side effect or it may change the severity. The side effects associated with Doxifos are listed below. You can use the underlined links to find out more about each one. For general information, see our cancer drug side effects section.

You usually have chemotherapy as cycles of treatment. The doxorubicin and ifosfamide chemotherapy can be given in several ways. They are all similar and each cycle lasts for 3 weeks. But the number of days you have treatment during each cycle varies between one and five days. You may have between 4 to 6 cycles. This takes between 3 and 4 months.

Doxorubicin is a red fluid. Ifosfamide is a clear fluid. You have the drugs into your bloodstream (intravenously). You can have them through a thin, short tube (a cannula) put into a vein in your arm each time you have treatment. Or you may have them through a central line, a portacath, or a PICC line. These are long, plastic tubes that give the drugs directly into a large vein in your chest. You have the line put in just before your course of treatment starts and it stays in place as long as you need it.

You may have both drugs by drip (infusion) or doxorubicin may be given by injection into your central line. You usually have ifosfamide with another drug called mesna. Mesna is not a chemotherapy drug. It stops the ifosfamide from irritating your bladder and causing bleeding. This side effect is called haemorrhagic cystitis. You usually have mesna into a vein, but sometimes you have it as tablets you take at home.

There are different ways (schedules) of having doxorubicin and ifosfamide chemotherapy. Your doctor or nurse will discuss with you which one you have and why. Some of the commonly used ones are described below.

Schedule A

On the first day of the treatment cycle you start an ifosfamide and mesna drip which continues for 3 days. Sometimes you may have this for 5 days. You also have a slow injection of doxorubicin through your cannula or central line on the first, second and third day. You need to stay in hospital for this treatment. When the drip is finished you can go home. You then have no treatment for the next 16 to 18 days. This completes one cycle of your chemotherapy.

Schedule B

On the first day of the treatment cycle you have an injection of doxorubicin plus a four hour drip (infusion) of ifosfamide. You take mesna as tablets. This treatment is repeated on day 2 and day 3. Having treatment in this way means that you don’t have to stay in hospital for the whole 3 days. You can go home each day in between your treatments. After the third day of treatment you have no treatment for 18 days. This completes one cycle of your chemotherapy.

Schedule C

On the first day of the treatment cycle you have an injection of doxorubicin into your cannula or central line plus a four hour drip (infusion) of ifosfamide. You have a mesna injection before you start the ifosfamide infusion and another two doses four and eight hours later. You have this treatment again the next day. You will probably need to stay in hospital for the 2 days of treatment. You can then go home and have no treatment for 19 days. This completes one cycle of your chemotherapy.

Schedule D

On the first day of the treatment cycle you have an injection of doxorubicin plus a 24 hour drip (infusion) of ifosfamide. You have a mesna injection before you begin your ifosfamide drip and also a 24 hour mesna infusion running alongside your ifosfamide. You will need to stay in hospital overnight. You then go home and have no treatment for 20 days. This completes one cycle of your chemotherapy.

More than 10 in every 100 people have one or more of the side effects listed below.

A temporary drop in the number of blood cells made by the bone marrow, causing

• An increased risk of getting an infection from a drop in white blood cells – it is harder to fight infections and you can become very ill. You may have headaches, aching muscles, a cough, sore throat, pain passing urine or feel cold and shivery
• Tiredness and breathlessness due to a drop in red blood cells (anaemia) – you may need a blood transfusion
• Bruising more easily due to a drop in platelets – you may have nosebleeds, bleeding gums after brushing your teeth, or lots of tiny red spots or bruises on your arms or legs (known as petechia)

Some of these side effects can be life threatening, particularly infections. You should contact your treatment centre if you have any of these effects. Your doctor will check your blood counts regularly to see how well your bone marrow is working.

Other common side effects include

• Fatigue (tiredness) during and after treatment – most people find their energy levels are back to normal within 6 months to a year
• Feeling or being sick – this is usually well controlled with anti sickness medicines – if you are still being sick, tell your doctor or nurse
• Complete hair loss affects nearly everyone who takes these drugs but this is temporary and your hair will grow back after the treatment ends
• A sore mouth can affect up to 5 out of 10 people
• Sensitivity to the sun – cover up and stay in the shade while you are having this treatment
• Watery eyes occur in more than 2 out of 10 people – it may last for several days after the start of each treatment
• Doxorubicin can make your urine turn pink for one or two days after treatment – this is not harmful
• Ifosfamide can cause irritation of the bladder and kidneys so it is important to drink as much water as possible to flush it out – you may have fluids into your drip before and after your treatment and should take your mesna treatment as prescribed
• Your nails may become ridged – or they may get darker and white lines may appear on them
• Women may stop having periods but this may be temporary
• Doxorubicin and ifosfamide may have a harmful effect on a developing baby – do talk to your doctor or nurse about contraception before having treatment if there is any chance that you or your partner could become pregnant
• Loss of fertility – we don’t know exactly how these drugs affects fertility so talk with your doctor before starting treatment if having a baby is important to you
• More than 1 in 10 people (12%) have confusion, sleepiness or extreme lack of energy (lethargy) and hallucinations – let your doctor or nurse know immediately if you have any of these
• Diarrhoea occurs in more than 1 in 10 people (12%) – drink plenty of fluids and tell your doctor or nurse if diarrhoea becomes severe or continues for more than 3 days

Between 1 and 10 in every 100 people have one or more of these.

• Temporary liver changes – you will have blood tests to see how well your liver is working
• A skin rash, which may be itchy
• Reddening of the skin in areas where you have had radiotherapy in the past, and the skin may get dry and flaky and feel sore and hot – this goes away on its own but keep affected areas out of the sun
• Temporary darkening of the skin
• Inflammation around the drip site – if you notice any signs of redness, swelling or leaking at your drip site, tell your chemotherapy nurse immediately
• An allergic reaction affects 3 people out of 100 (3%) when they have doxorubicin so let your doctor or nurse know if you have a sudden rash of pink, itchy bumps on your skin and a reddening of the skin along the veins – it should clear up within a few days
• Damage to heart muscle, which is usually temporary but for a small number of people may be permanent – your doctor will check your heart before and after your treatment
• Loss of appetite
• Fever and chills

Fewer than 1 in 100 people have these.

• Sore eyes
• If you have a high dose or many treatments with doxorubicin there is a small risk that you may get a second cancer some years later

You may only have 1 or 2 side effects or you may have a few. A side effect may get worse through your course of treatment. Or you may have more side effects as the course goes on. This depends on

• How many times you've had a drug before
• Your general health
• How much of the drug you have (the dose)
• Other drugs you are having

Talk to your doctor, pharmacist or nurse about all your side effects so they can help you manage them. Your nurse will give you a contact number to ring if you have any questions or problems. 

Tell your doctor about any other medicines you are taking, including vitamins, herbal supplements and over the counter remedies – some drugs can react together.

You should not have immunisations with live vaccines while you are having this treatment or for at least 6 months afterwards. In the UK, live vaccines include rubella, mumps, measles (usually given together as MMR), BCG and yellow fever. You can have other vaccines, but they may not give you as much protection as usual until your immune system has fully recovered.

It is safe for you to be in contact with other people who've had live vaccines as injections. There can be problems with oral vaccines, but not many people in the UK have oral vaccines now. So there is usually no problem in being with any baby or child who has recently had any vaccination in the UK. You might need to make sure that you aren't in contact with anyone who has had oral polio, cholera or typhoid vaccination recently, particularly if you live abroad.