High-dose
ifosfamide (one or two courses of 6 g/m2) with or without
mesna was administered to 13 patients with advanced
non-small cell lung cancer. The protective effect of 2-mercapto-ethane sulfonate (
mesna) against the urotoxic side effects induced by
ifosfamide was examined by a randomized crossover trial. A significant reduction in the incidence of
hematuria was observed in the patients receiving
mesna. Macroscopic
hematuria was observed in only one patient who received treatment with
mesna versus seven patients treated with
ifosfamide alone. Other symptoms, such as frequency and
dysuria, tended to be diminished in the patients receiving
mesna, although the difference was not statistically significant. Our results suggest that
mesna is effective in preventing or diminishing
ifosfamide-induced
hemorrhagic cystitis. Concomitant use of
mesna should allow the administration of a high dose of
ifosfamide although more extensive studies are needed to define the optimal dose and schedule of administration of
mesna to prevent or attenuate the
hemorrhagic cystitis.