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Cochrane Database of Systematic Reviews

Cyclophosphamide versus ifosfamide for paediatric and young


adult bone and soft tissue sarcoma patients (Review)

Mulder RL, Paulides M, Langer T, Kremer LCM, van Dalen EC

Mulder RL, Paulides M, Langer T, Kremer LCM, van Dalen EC.


Cyclophosphamide versus ifosfamide for paediatric and young adult bone and soft tissue sarcoma patients.
Cochrane Database of Systematic Reviews 2015, Issue 9. Art. No.: CD006300.
DOI: 10.1002/14651858.CD006300.pub4.

www.cochranelibrary.com

Cyclophosphamide versus ifosfamide for paediatric and young adult bone and soft tissue sarcoma patients (Review)
Copyright © 2015 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.
[Intervention Review]

Cyclophosphamide versus ifosfamide for paediatric and young


adult bone and soft tissue sarcoma patients

Renée L Mulder1 , Marios Paulides2a , Thorsten Langer3 , Leontien CM Kremer1 , Elvira C van Dalen1
1 Department of Paediatric Oncology, Emma Children’s Hospital/Academic Medical Center, Amsterdam, Netherlands. 2 Drug Com-
mission of the German Medical Association, Berlin, Germany. 3 Pediatric Oncology Hematology, University Hospital for Children and
Adolescents, Lübeck, Germany
a
Joint first authorship with Renée L Mulder

Contact address: Renée L Mulder, Department of Paediatric Oncology, Emma Children’s Hospital/Academic Medical Center, P.O.
Box 22660, Amsterdam, 1100 DD, Netherlands. r.l.mulder@amc.uva.nl.

Editorial group: Cochrane Childhood Cancer Group.


Publication status and date: New search for studies and content updated (no change to conclusions), published in Issue 9, 2015.
Review content assessed as up-to-date: 23 March 2015.

Citation: Mulder RL, Paulides M, Langer T, Kremer LCM, van Dalen EC. Cyclophosphamide versus ifosfamide for paediatric and
young adult bone and soft tissue sarcoma patients. Cochrane Database of Systematic Reviews 2015, Issue 9. Art. No.: CD006300. DOI:
10.1002/14651858.CD006300.pub4.

Copyright © 2015 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.

ABSTRACT
Background
Alkylating agents, such as cyclophosphamide and ifosfamide, play a major role in the improved survival of children and young adults
with bone and soft tissue sarcoma. However, there is still controversy as to their comparative anti-tumour efficacy and possible adverse
effects. This is the second update of the first systematic review evaluating the state of evidence on the effectiveness of cyclophosphamide
as compared to ifosfamide for paediatric and young adult patients with sarcoma.
Objectives
The primary obective was to compare the effectiveness, that is response rate, event-free survival and overall survival, of cyclophosphamide
with that of ifosfamide for paediatric and young adult patients with sarcoma. Secondary objectives were to determine effects of these
agents on toxicities (including late effects) and quality of life.
Search methods
We searched CENTRAL (The Cochrane Library 2015, issue 2), MEDLINE/PubMed (from 1966 to March 2015) and EMBASE/Ovid
(from 1980 to March 2015) with prespecified terms. In addition, we searched reference lists of relevant articles, conference proceedings
and ongoing trial databases (www.controlled-trials.com; searched June 2015).
Selection criteria
Randomised controlled trials (RCTs) or controlled clinical trials (CCTs) comparing cyclophosphamide and ifosfamide for the treatment
of different types of sarcoma in paediatric and young adult patients (aged less than 30 years at diagnosis). Chemotherapy other than
either cyclophosphamide or ifosfamide should have been the same in both treatment groups.
Data collection and analysis
Two authors independently performed the study selection.
Cyclophosphamide versus ifosfamide for paediatric and young adult bone and soft tissue sarcoma patients (Review)
Copyright © 2015 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.
Main results
No studies meeting the inclusion criteria of the review were identified.
Authors’ conclusions
No RCTs or CCTs comparing the effectiveness of cyclophosphamide and ifosfamide in the treatment of bone and soft tissue sarcoma in
children and young adults were identified. Therefore no definitive conclusions can be made about the effects of cyclophosphamide and
ifosfamide in these patients. Based on the currently available evidence, we are not able to give recommendations for clinical practice.
More high-quality research is needed.

PLAIN LANGUAGE SUMMARY


Cyclophosphamide compared to ifosfamide for the treatment of sarcoma in children and young adults
Sarcomas are tumours that arise from bone and soft tissues. They can occur in all ages. As a result of the introduction of polychemotherapy,
the survival of children and young adults with different types of sarcoma has improved dramatically. Alkylating agents, such as
cyclophosphamide and ifosfamide, have played a major role in this improvement. However, in the literature there is still no consensus
as to which chemotherapeutic agent is more effective. A well-informed decision on the use of cyclophosphamide and ifosfamide in
the treatment of children and young adults diagnosed with a sarcoma should be based on high-quality evidence on both anti-tumour
efficacy and adverse effects.
This systematic review focused on (ideally randomised) controlled studies. We found that there were no such studies comparing
cyclophosphamide and ifosfamide in paediatric and young adult sarcoma patients. More high-quality research is needed.

Cyclophosphamide versus ifosfamide for paediatric and young adult bone and soft tissue sarcoma patients (Review)
Copyright © 2015 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.