Retrospective cohort study of feasibility and safety of ifosfamide-based regimens for sarcomas in the outpatient setting

Ifosfamide is traditionally administered in an inpatient setting because of risks of neurotoxicity and hemorrhagic cystitis. A retrospective cohort study at Moffitt Cancer Center (Tampa, FL) evaluated feasibiltiy and safety of administring ifosfamide-based chemotherapy regimens for sarcoma in an outpatient setting. The study included patients aged 18-60 years, treated with MAI (mesna, doxorubicin, and ifosfamide) or IE (ifosfamide and etoposide) between 2018 and 2024. Figty-eight patients receiving MAI or IE were managed either through the outpatient servise or in the inpatient setting. The outpatient service saved an estimated 16.2 bed-days per patient and 3.7 bed-days per cycle. Clinical outcomes were comparable, with similar readmission rates (18.1% versus 19.2%) and urgent care visit rates (5.5% versus 4.8%), without reported cases of hemorrhagic cystitis. Grade ≥ 3 hematologic toxicities and treatment completion rates (> 90%) were also similar across arms. The authors conclude that these findings demonstrate that ifosfamide-based regimens through a structured outpatient model are safe and reducing hospital resource utilization while maintaining treatment adherence.