How is AIM (Adriamycin, Ifosfamide, Mesna) chemotherapy administered?

AIM Chemotherapy Administration Protocol

AIM (Adriamycin, Ifosfamide, Mesna) chemotherapy is administered intravenously with Adriamycin given as a short infusion on day 1, while Ifosfamide is given daily for 5 days with concurrent Mesna protection to prevent hemorrhagic cystitis.

Components of AIM Regimen

The AIM regimen consists of:

• Adriamycin (Doxorubicin): 60 mg/m² IV on day 1 as a 2-hour infusion 1
• Ifosfamide: 1200-2500 mg/m² IV daily for 5 days 2, 1
• Mesna: Administered with ifosfamide to prevent hemorrhagic cystitis

Mesna Administration Protocol

Mesna can be administered in two ways with ifosfamide:

Option 1: Intravenous-only Protocol 3

• Initial dose: 20% of ifosfamide dose given as IV bolus at time of ifosfamide administration
• Follow-up doses: 20% of ifosfamide dose given IV at 4 hours and 8 hours after each ifosfamide dose
• Total daily mesna dose: 60% of the ifosfamide dose

Option 2: IV/Oral Combination Protocol 3

• Initial dose: 20% of ifosfamide dose given as IV bolus at time of ifosfamide administration
• Follow-up doses: 40% of ifosfamide dose given orally at 2 hours and 6 hours after each ifosfamide dose
• Total daily mesna dose: 100% of the ifosfamide dose

Administration Schedule

The standard administration schedule is:

• Treatment is typically given in 21-day cycles 1
• Ifosfamide and mesna are administered on days 1-5 of each cycle
• Adriamycin is administered on day 1 of each cycle

Practical Administration Considerations

• Hydration: Adequate hydration must be maintained throughout treatment
• Monitoring: Regular urine monitoring for hematuria is essential 3
• Infusion methods:
  • Ifosfamide can be given as daily infusions or as continuous infusion over 5 days 4
  • Continuous infusion may be associated with lower risk of encephalopathy 5

Ambulatory Administration Option

For patient convenience and cost-effectiveness:

• Ifosfamide and mesna can be administered as continuous infusion using portable infusion pumps 4
• This approach allows outpatient administration with significant cost savings
• Total cost for ambulatory infusion is approximately 30% of conventional hospitalization costs 4

Toxicity Management

Common toxicities to monitor and manage:

• Hematological: Grade 3-4 myelosuppression occurs in approximately 10-20% of patients 4, 6
• Neurological: Monitor for encephalopathy, which occurs in up to 17% of patients on high-dose regimens 6
• Genitourinary: Despite mesna, monitor for hematuria; if severe, ifosfamide dose reduction may be required 3

Special Considerations

• If a patient vomits within 2 hours of taking oral mesna, the dose should be repeated or switched to IV administration 3
• Mesna tablets are available in 400-mg tablets for oral administration 2
• The AIM regimen is considered one of the most active chemotherapy regimens for unselected patients with soft tissue sarcoma 2

AIM chemotherapy requires careful administration by experienced teams with full supportive care capabilities due to its potential for significant toxicity, but it remains an important treatment option for patients with soft tissue sarcomas.