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Treatment Name: AIM (Adriamycin® + Ifosfamide + Mesna)

AIM (Adriamycin® + Ifosfamide + Mesna) is a Chemotherapy Regimen for Sarcoma

How does AIM work?
Each of the medications in AIM are designed to kill and slow growth of cancer cells.

A – Adriamycin (Doxorubicin)
I   - Ifosfamide
M - Mesna 

Goals of therapy:
AIM is given to shrink tumors and alleviate symptoms of sarcoma. AIM may be given with the goal of cure, and while not always curative, it may still relieve symptoms and prolong life.

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Schedule

  • Doxorubicin intravenous (I.V.) infusion over 5 - 20 minutes on Days 1, 2, and 3
  • Ifosfamide I.V. over four hours on Days 1, 2, 3, and 4
  • Mesna I.V. over four hours on Days 1, 2, 3, and 4 followed by two more I.V. or oral doses the same day

Click here for common AIM starting doses.

Mesna is not a chemotherapy agent. It binds to and neutralizes a toxic metabolite of ifosfamide known as acrolein.

Estimated total infusion time:

  • In an outpatient infusion center it can take 5 to 6 hours each day if a patient can leave after the ifosfamide and take oral mesna at home.  It could take up to 9 or 10 hours if the two post-ifosfamide mesna doses are given I.V. at the infusion center
  • In a hospital, the patient will be there for 4 to 5 days due to lengthy chemotherapy infusions and side effect management

AIM is repeated every 21 days. This is known as one Cycle. Each cycle may be repeated up to six times, depending upon the stage of the disease. Duration of therapy may last up to six months, depending upon response, tolerability, and number of cycles prescribed.

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Side Effects

In a multi-drug regimen, each medication has unique side effects. When these medicines are given together, drug-related side effects reported in clinical studies give the best estimate of what to expect. In clinical studies, the most commonly reported side effects with AIM are shown here:

On average, 17% of patients discontinue AIM due to unacceptable side effects.

Side effect videos Side Effect Videos
Nausea and VomitingNausea and VomitingFatigue Fatigue Hair LossHair LossNeutropenic FeverNeutropenic FeverConstipationConstipationAnemiaAnemiaDiarrheaDiarrheaBleedingBleedingPainPainBlood ClotsBlood Clots

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Monitoring

How often is monitoring needed?
Labs (blood tests) may be checked before treatment and periodically during treatment. Labs often include: Complete Blood Count (CBC), Comprehensive Metabolic Panel (CMP), plus any others your doctor may order. A urinalysis is typically performed daily while receiving ifosfamide to check for blood in the urine. Doctors or nurses commonly check for neurotoxicity. This means BEFORE each dose, doctors ask if a patient can say their name, ask if they know the date and place where they are presently located, and other simple tests to assess brain function.

How often is imaging needed?
Imaging may be checked before treatment and as often as after every two cycles of therapy. Imaging may include: computerized tomography (CT) scans, magnetic resonance imaging (MRI), or X-rays.

How might blood test results/imaging affect treatment?
Depending upon the results, your doctor may advise to continue AIM as planned, or delay or switch therapy.

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ChemoExperts Tips

  • Typically, filgrastim (Neupogen®) or pegfilgrastim (Neulasta®) is given after chemotherapy to stimulate production of white blood cells, avoid periods of low white blood cell count (neutropenia), and prevent infection
  • Intravenous (I.V.) fluids may be given while receiving ifosfamide to maintain good hydration and protect against kidney and bladder damage
  • Mesna tablets taste terrible and can make a nauseated patient feel worse. If a patient vomits within two hours of taking oral mesna, they should contact their doctor to see if another dose is needed
  • Mesna tablets are very expensive and not always covered by insurance plans (outpatient pharmacy plans). Your doctor should be able to have someone check ahead of time what the out-of-pocket cost is
  • I.V. mesna is sometimes diluted with water and given by mouth as an alternative to the tablet. The reason is that the I.V. vials are far less expensive than oral tablets. If mesna tablets are too expensive, talk to your doctor or pharmacist about possibly using the I.V. form by mouth to save money
  • A pharmacist should ALWAYS review your medication list to ensure that drug interactions are prevented or managed appropriately
  • Clinical trials may exist for soft tissue sarcoma. Ask your doctor if any studies are currently enrolling in your area. If not, go to clinicaltrials.gov to search for other centers offering study medications

Patient Assistance & Co-payment Coverage

Patients under the age of 65 years, or those with private insurance plans:
If you have insurance and are looking for patient assistance or copay assistance for AIM (Adriamycin® + Ifosfamide + Mesna), we have provided links that may help.

Visit our Patient Assistance page and click the links to various patient assistance programs for help paying for AIM (Adriamycin® + Ifosfamide + Mesna). Depending upon your income, they may be able to help cover the cost of:

  • Doxorubicin
  • Ifosfamide
  • Mesna

For Branded medications (may be available for generic medications too), check with the manufacturer to determine if a co-pay card is offered and if it could reduce your monthly copay.

  • If you are uninsured, check with the manufacturer to determine if you are eligible to receive medication at no cost.

Medicare and Medicaid patients (Patients 65 years or older):
The clinic providing treatment will likely pre-authorize medications and immune therapies such as AIM (Adriamycin® + Ifosfamide + Mesna) and are the best source to help you understand drug cost.

  • Ask to speak with a patient assistance technician or financial counselor at the clinic or hospital administering this therapy.

Emotional Wellness

What is Emotional Wellness?
Emotional wellness is having a positive outlook balanced with a realistic understanding of current life events. This requires both an awareness and acceptance of your emotions. It is with this knowledge that you can develop a plan to take the necessary actions to positively impact your life.

Emotional wellness uses an ongoing process to continually reflect on the stressors of life in a constructive manner to move forward and create happiness.

Because emotional wellness is deeply connected with physical, social, and spiritual wellness, pursuing it often becomes particularly difficult in times of major illness. Despite this difficulty, working toward emotional wellness has been connected to improved treatment outcomes and a higher likelihood of achieving goals of therapy.

Learn more about pursuing emotional wellness while receiving treatment with AIM (Adriamycin® + Ifosfamide + Mesna)

Individual Drug Label Information

Doxorubicin (Adriamycin®)

  • Doxorubicin is administered as an intravenous infusion and is red in color
  • Can affect heart function. A heart study (echocardiogram) may be required before receiving the first dose
  • Dosage may be reduced in patients with poor liver function
  • Has been linked to the development of other cancers in a small number of people (1.5% chance at 10 years)
General Doxorubicin (Adriamycin) Side Effects
  • Nausea, vomiting, diarrhea, and mouth sores (stomatitis)
  • Leakage into skin or surrounding muscle during infusion may cause severe irritation (extravasation)
  • May temporarily turn urine orange
  • Hair loss, which is usually reversible
  • Increased risk of infection due to decrease white blood cell count (neutropenia)
  • Click on the doxorubicin (Adriamycin) package insert for reported side effects and possible drug interactions

Side Effect Videos
Nausea and VomitingNausea and VomitingDiarrheaDiarrheaHair LossHair LossPainPainNeutropenic FeverNeutropenic Fever

See DailyMed package insert.

Ifosfamide (Ifex®)

  • Ifosfamide is an intravenous (I.V.) infusion
  • Has been linked to the development of other cancers in a small number of people 
  • Your blood counts will be monitored closely while on therapy and your chemotherapy may need to be delayed due to low red blood cells, white blood cells, and platelets
  • Symptoms of neurotoxicity from ifosfamide include tiredness, confusion, dizziness, mood changes, hallucinations, seizure, and coma. You will be checked for any signs of neurotoxicity prior to receiving each dose of ifosfamide. If these occur during treatment, ifosfamide infusion should be interrupted until the symptoms go away
  • Bladder irritation may occur and result in blood in the urine. This may appear as pink urine, or bright red, depending upon how much blood is being lost. Drink plenty of fluids (1-2 liters/day), especially during the days when ifosfamide is given. Frequent urination will also help flush the bladder and avoid bladder irritation
  • Your kidney function will be monitored while on therapy with ifosfamide. Dosage adjustments may be required for decreased kidney function
  • A smaller dosage may be required for patients receiving hemodialysis
  • May decrease the ability to become pregnant. Fertility preservation is recommended in couples wishing to become pregnant
  • Has been linked to the development of other cancers in a small number of people
General Ifosfamide (Ifex) Side Effects 
  • Can cause lung toxicity leading to decreased lung function
  • Commonly causes hair loss, which is usually reversible
  • Has been linked to the development of other cancers in a small number of people
  • Low white blood cell count which can increase the risk of infection
  • Nausea or vomiting, which can be acute (first 24 hours) or delayed (Days 2 – 5)
  • Click on the Ifosfamide (Ifex) package insert below for reported side effects and possible drug iteractions

Side Effect Videos
DiarrheaDiarrheaHair LossHair LossFatigue Fatigue PainPainAnemiaAnemiaNeutropenic FeverNeutropenic Fever

See DailyMed package insert.

Mesna (Mesnex®)

  • Mesna is an intravenous drug AND an oral tablet
  • Mesna is not chemotherapy
  • Mesna protects the cells lining the bladder from toxicity caused by ifosfamide and its metabolites. Without mesna, ifosfamide would cause bleeding in the bladder
  • Commonly given as three separate intravenous (I.V.) doses or one initial I.V. dose followed by two oral tablet doses spaced four hours apart
  • Tablets are only available in 400 mg strength. Doses are rounded to whole tablet
General Mesna (Mesnex) Side Effects
  • Allergic reactions (hypersensitivity) can occur
  • Skin rash rarely occurs
  • Benzyl alcohol toxicity from the I.V. formulation, usually only with infants
  • Click on the mesna (Mesnex) package insert below for reported side effects and possible drug interactions

Side Effect Videos

See DailyMed package insert.

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References

Judson I, Verweij J, Gelderblom H,et al. Doxorubicin alone versus intensified doxorubicin plus ifosfamide for first-line treatment of advanced or metastatic soft-tissue sarcoma: a randomised controlled phase 3 trial. Lancet Oncol 2014;15:415-23.

Created: December 7, 2015 Updated: May 4, 2017

What is Sarcoma?

A name given to a type of cancer based on the body tissue the cancer cells most closely resemble. Examples include liposarcoma resembling fat tissue, osteosarcoma resembling bone tissue, leiomyosarcoma resembling smooth muscle tissue, and chondrosarcoma resembling cartilage tissue. Another way doctors classify sarcomas is by grade: high, low, and intermediate.

Sarcomas are treated with surgery (including amputation), chemotherapy, radiation therapy, or a combination of these. Chemotherapy for sarcomas can last for many months, to more than one year. The stage of sarcoma can vary at diagnosis and throughout treatment. The Tumor, Node, Metastatis (TNM) staging system is used to describe different areas of cancer growth along with Stage Grouping using Stages I, II, III, or IV. Staging systems describe the extent of cancer throughout the body and help doctors determine which treatments to offer. The effectiveness of the treatment may depend upon the stage at diagnosis.

NOTE: Treatment Options listed below are not all-inclusive. Other treatments may be available. ChemoExperts provides drug information and does not recommend any one treatment over another. Only your Doctor can choose which therapy is appropriate for you.

What is acrolein?

It is a breakdown product (metabolite) of ifosfamide. If too much acrolein builds up in the bladder, it harms the cells lining the bladder and causes bleeding. Mesna helps lessen the risk of this side effect by binding to and neutralizing acrolein.

Common Starting Doses for AIM

  • Doxorubicin 75 mg/m2 IV push over 5 - 20 minutes on Day 1
  • Ifosfamide 2500 mg/m2 IV over four hours on Days 1, 2, 3, and 4
  • Mesna 1500 mg/m2 IV over four hours on Days 1, 2, 3, and 4, follow by two oral Mesna doses of 1000 mg/m2 at 2 and 6 hours after finishing ifosfamide

*Inpatient (hospital) regimens may infuse doxorubicin as a 3-day continuous infusion with ifosfamide + mesna as a 4-day continuous infusion.

Note: Individual doses may vary based upon your Doctor's recommendation, or drug availability

What is a CBC?

A Complete Blood Count (CBC) is a frequently ordered blood test that tells clinicians the status of your: 1) White blood cell count, 2) Hemoglobin, and 3) Platelet count at the time the test was taken.

Common uses:
1) White blood cell count (WBC): is used to determine infection risk, or response to chemotherapy. Certain chemotherapy agents may harm our good infection-fighting cells. Sometimes chemotherapy may need to be delayed to allow these cells to recover.

2) Hemoglobin: is used to determine if someone is anemic. Anytime the hemoglobin is below 12 g/dL, the person is said to be anemic. Red blood cell transfusions, and sometimes iron can be given to restore the hemoglobin level, but anemia treatment should always aim at treating the underlying cause or condition.

3) Platelet count: is used to determine if the risk of bleeding is increased or if a platelet transfusion is required to prevent bleeding. Certain medications that increase bleeding risk, such as: aspirin, certain chemotherapy agents, and blood thinners, may need to be stopped temporarily until the platelet count is within a safe range.

What is a CMP?

A Comprehensive Metabolic Panel (CMP) is a frequently ordered blood test that tells clinicians the status of your: 1) Electrolytes & Acid/Base status2) Kidney function, 3) Liver function, 4) Blood sugar, and 5) Calcium at the time the test was taken. It is commonly used to monitor liver and kidney function when beginning new medications such as chemotherapy. A total of 14 tests are run simultaneously and are shown below.

Electrolytes & Acid/Base status:
1) Sodium, 2) Potassium, 3) Carbon dioxide, 4) Chloride

Kidney Function:
5) BUN (blood urea nitrogen), 6) Serum creatinine (Scr)

Liver Function:
7) AST, 8) ALT, 9) Total bilirubin, 10) Alk Phos, 11) Albumin, 12) Total protein

Blood sugar:
13) Serum glucose

Calcium:
14) Serum calcium

What does "cure" mean?

The word “cure” means there are no cancer cells left in the body and cancer will never come back. Depending on the cancer type and stage, this may be the true goal of therapy. However, it is very difficult to prove all cancer cells are gone. Even though images, like X-rays and MRI’s, and blood tests may not show any signs of cancer, there can be a small amount of cancer cells still left in the body. Because of this, doctors use the word “remission” is used more often. This means there are no signs or symptoms of cancer. Patients in remission are followed closely for any signs of cancer returning. Sometimes, more chemotherapy may be given while in remission to prevent the cancer from coming back.

Doctors usually do not consider a patient “cured” until the chance of cancer returning is extremely low. If cancer does return, it usually happens within 5 years of having a remission. Because of this, doctors do not consider a patient cured unless the cancer has not come back within 5 years of remission. The five-year cutoff does not apply to all cancers.