Phosphorodiamidates

Cyclophosphamide (CP), also known as cytophosphane among other names, is a medication used as chemotherapy and to suppress the immune system. As chemotherapy it is used to treat lymphoma, multiple myeloma, leukemia, ovarian cancer, breast cancer, small cell lung cancer, neuroblastoma, and sarcoma. As an immune suppressor it is used in nephrotic syndrome, ANCA-associated vasculitis, and following organ transplant, among other conditions. It is taken by mouth or injection into a vein.

Ifosfamide, sold under the brand name Ifex among others, is a chemotherapy medication used to treat a number of types of cancer. This includes testicular cancer, soft tissue sarcoma, osteosarcoma, bladder cancer, small cell lung cancer, cervical cancer, and ovarian cancer. It is administered by injection into a vein.

Trofosfamide (INN) is a nitrogen mustard alkylating agent. It is sometimes abbreviated "TRO". It has been used in trials to study its effects on ependymoma, medulloblastoma, sarcoma, soft tissue, supratentorial PNET, and recurrent brain tumors.

Mafosfamide (INN; development code ASTA-Z-7557) is an oxazaphosphorine (cyclophosphamide-like) alkylating agent under investigation as a chemotherapeutic. It is metabolized by cytochrome P450 into 4-hydroxycyclophosphamide, which is then converted into aldophosphamide, which, in turn yields the cytotoxic metabolites phosphoramide mustard and acrolein.

4-Hydroxycyclophosphamide is in the class of oxazaphosphorine compounds, and is the main, active metabolite of cyclophosphamide and of mafosfamide after they partially metabolized by cytochrome P450. It is then partially tautomerized into aldophosphamide, which, in turn, easily enters live cells and then is partially detoxified into inactive carboxycyclophosphamide by the enzyme ALDH, but partially is hydrolyzed by another cell's enzyme phosphatase to the two directly cytotoxic metabolites - phosphoramide mustard and acrolein.