AIM

Say it: AIM (like the word)

Doxorubicin, ifosfamide and mesna

AIM is a strong chemotherapy for sarcoma that combines doxorubicin and ifosfamide, with mesna to protect the bladder.

Also called: AI, doxorubicin and ifosfamide, Adriamycin ifosfamide mesna, dox ifos, MAI, MAID

What it is

Doxorubicin and ifosfamide are two of the most active medicines against sarcoma, and together they shrink tumors more often than either alone. Mesna is not a cancer medicine. It protects your bladder from a harmful breakdown product of ifosfamide. The goal may be to shrink a tumor before surgery, lower the chance of return after surgery, or control cancer that has spread.

Often used for

• Soft tissue sarcoma that has spread or cannot be removed
• Soft tissue sarcoma before or after surgery in some higher risk cases
• Some bone sarcomas

MAID

Dacarbazine is added to the same medicines. It is used less often today, but some centers still use it.

Doxorubicin alone

For some people, doxorubicin by itself is used instead because it has fewer side effects. AIM shrinks tumors more often but is harder on the body.

The medicines in this plan

Doxorubicin (Adriamycin)

An anthracycline chemotherapy (a red medicine). Given through a vein, often split over the first 1 to 3 days.

Ifosfamide

An alkylating chemotherapy. Given through a vein each day for 3 to 4 days.

Mesna

A protective medicine, not chemotherapy. Given through a vein (and sometimes as pills) with each ifosfamide dose to protect the bladder from bleeding.

How you get it

AIM is often given during a hospital stay of 3 to 5 days, though some centers give it in the clinic with a portable pump. Cycles repeat every 21 days, usually for 4 to 6 cycles. A port is usually placed. A white blood cell shot is given after each cycle. Your schedule may be different.

A typical cycle

Day 1

Admission or clinic visit, blood tests, fluids, then IV doxorubicin, ifosfamide and mesna begin.

Days 1 to 3 or 4

Ifosfamide and mesna each day, with lots of IV fluids. Urine is checked for blood.

Day 4 or 5

Treatment ends, and a white blood cell shot is given before or after you go home.

Days 7 to 14

Blood counts are lowest. Risk of fever and infection is highest.

Days 15 to 21

Recovery before the next cycle.

Common side effects and what helps

• Very low blood counts. Watch closely for fever and wash hands often.
• Nausea and vomiting. Take nausea medicines on schedule.
• Hair loss, usually complete. It grows back after treatment.
• Deep tiredness that can last a week or more after each cycle. Rest and gentle walks help.
• Mouth sores. Use a soft toothbrush and rinse often.
• Red or pink urine from doxorubicin for a day or two. Blood in the urine is different and must be reported.
• Sleepiness, confusion or strange dreams from ifosfamide. Family should watch for this and tell the nurse.
• Low potassium, phosphate or other salts from kidney effects. Blood tests check this.
• Loss of appetite. Eat small meals and snacks often.

Call your care team right away if you have

• A fever of 100.4 degrees Fahrenheit (38 degrees Celsius) or higher, or chills
• Blood in your urine, or pain when you urinate
• Confusion, extreme sleepiness, seeing things that are not there, or a seizure
• Shortness of breath, chest pain or swelling in the legs
• Vomiting that keeps you from drinking fluids
• Making much less urine than usual
• Bleeding or many new bruises

Good to know

• A heart test (echocardiogram or MUGA scan) is done before starting because doxorubicin can weaken the heart.
• Mesna and lots of fluids are needed with every ifosfamide dose to protect the bladder.
• Ifosfamide can cause confusion (encephalopathy). The team checks your thinking each day, and a medicine called methylene blue may be used if it happens.
• Kidney function and blood salts are checked often, since ifosfamide can harm the kidneys.
• A white blood cell shot is usually given after each cycle.
• This treatment can affect fertility. Ask about sperm or egg banking before starting.

At home

• Drink plenty of fluids and urinate often for several days after treatment.
• If you take mesna pills at home, take them exactly on time.
• Take your temperature if you feel unwell, and call for a fever.
• Have someone stay with you the first night home in case of confusion.
• Take nausea medicines on schedule.

Questions to ask

• Will I get this in the hospital or in the clinic?
• How many cycles will I get?
• Is the goal to shrink the tumor before surgery or to control it?
• What signs of confusion should my family watch for?
• How can I protect my fertility?

Sarcoma

Last updated: 2026-10-27. Medically reviewed by Veli Bakalov, MD, medical oncologist (October 2026). General education from Step by Step, the patient portal of HemeOncBuddy.