Uses
Cyclophosphamide may be used alone in susceptible malignancies, but more often is used in combination or sequentially with other antineoplastic agents.
Hodgkin’s Disease
Treatment of Hodgkin's disease as part of a combination regimen.
Non-Hodgkin’s Lymphoma
Treatment of various types of non-Hodgkin’s lymphoma, including high-grade (e.g., Burkitt’s, lymphoblastic) lymphomas and intermediate- or low-grade lymphomas, as part of a combination regimen.
Treatment of low-grade non-Hodgkin's lymphomas as a single agent.
Multiple Myeloma
Treatment of multiple myeloma, with prednisone or as part of a combination regimen.
As effective as melphalan; combination of either agent with prednisone is considered treatment of choice.
Leukemias
Treatment of chronic lymphocytic (lymphoblastic) leukemia; considered a drug of choice.
Used with busulfan as a conditioning regimen prior to allogeneic hematopoietic progenitor (e.g., stem) cell transplantation in patients with chronic myelogenous leukemia.
Treatment of acute lymphoblastic leukemia, especially in children.
Treatment of acute myeloid (myelogenous, nonlymphocytic) leukemia (AML, ANLL) and as an additional drug for induction or post-induction therapy.
In meningeal leukemia, concentrations of cyclophosphamide and metabolites in brain and CSF probably are insufficient for adequate treatment.
Cutaneous T-cell Lymphoma
Treatment of advanced mycosis fungoides, a form of cutaneous T-cell lymphoma, alone or in combination regimens.
Neuroblastoma
Treatment of disseminated neuroblastoma; a treatment of choice when included in combination chemotherapy.
Ovarian Cancer
Treatment of ovarian germ cell tumors† as part of an alternative combination regimen (vincristine, dactinomycin, and cyclophosphamide [VAC]) .
Also has been used with a platinum-containing agent to treat advanced (stage III or IV) epithelial ovarian cancer, but randomized studies indicate that paclitaxel combined with a platinum-containing agent produces higher response rates and more prolonged overall survival and therefore is preferred.
Retinoblastoma
Treatment of retinoblastoma as part of a combination regimen.
Breast Cancer
Treatment of breast cancer as part of a combination regimen; some experts suggest that such regimens are the treatment of choice.
Adjunct to surgery in combination regimens; such regimens increase disease-free (i.e., decreased recurrence) and overall survival in premenopausal and postmenopausal women with node-negative or -positive early (TNM stage I or II) breast cancer. Cyclophosphamide–methotrexate–fluorouracil regimen has been used extensively and is considered a regimen of choice.
Treatment of stage III (locally advanced) breast cancer (with or without hormonal therapy); drugs in combination regimens are administered sequentially following surgery and radiation therapy (for operable disease) or following biopsy and radiation therapy (for inoperable disease). Commonly used effective combination regimens include cyclophosphamide, methotrexate, and fluorouracil; cyclophosphamide, doxorubicin, and fluorouracil; and cyclophosphamide, methotrexate, fluorouracil, and prednisone.
Regimens for stage III disease (and other regimens) also have been used to treat more advanced (stage IV) and recurrent breast cancer.
Small Cell Lung Cancer
Treatment of extensive-stage small cell lung cancer†; used in combination regimens (e.g., cyclophosphamide, doxorubicin, and vincristine [CAV]; cyclophosphamide, doxorubicin, and etoposide [CAE]).
Sarcomas
Treatment of rhabdomyosarcoma†; used in combination regimens (e.g., with dactinomycin and vincristine) and as an adjunct to surgery and radiation therapy.
Used in combination regimens for Ewing’s sarcoma† as an adjunct to surgery and radiation therapy; considered a treatment of choice.
Nephrotic Syndrome
Treatment of selected cases of biopsy-proven minimal change nephrotic syndrome in children.
Not for initial therapy; has induced remission in patients unresponsive to appropriate corticosteroid therapy or in whom intolerable adverse effects (e.g., growth failure) occur.
Renal, Hepatic, Cardiac, and Bone Marrow Transplantation
Used as an immunosuppressant to control rejection following renal, hepatic, cardiac, or bone marrow transplantation†. Considered by some experts to be as effective as azathioprine for maintenance of renal allografts and more effective than azathioprine for maintenance of hepatic allografts.
Because of the potential for serious adverse effects, some experts recommend reserving immunosuppressive use of cyclophosphamide for patients who become refractory to corticosteroids or other less toxic agents, or limiting such use to short-term treatment when feasible.
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