The development of mesna for the inhibition of urotoxic side effects of cyclophosphamide, ifosfamide, and other oxazaphosphorine cytostatics.

Abstract

Urotoxic side effects on the kidneys and urinary bladder are a limiting factor in chemotherapy with oxazaphosphorine cytostatics such as cyclophosphamide and ifosfamide. Acrolein was found to be the causative factor which is spontaneously formed in the urine from the primary metabolites eliminated via the kidneys. Sodium 2-mercaptoethanesulfonate (INN: mesna) enables regional detoxification of acrolein in the kidneys and deferent urinary tract. The author reports on the pharmacotherapeutic bases and the mechanism of action of this new combination therapy and its clinical results. The untoward urotoxic side effects can be avoided with mesna without interfering with the chemotherapeutic effect on the tumor.