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Last Updated: March 27, 2026

CLINICAL TRIALS PROFILE FOR CYTOXAN


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505(b)(2) Clinical Trials for CYTOXAN

This table shows clinical trials for potential 505(b)(2) applications. See the next table for all clinical trials
Trial Type Trial ID Title Status Sponsor Phase Start Date Summary
New Dosage NCT01760226 ↗ Dose Adjusted EPOCH-R, to Treat Mature B Cell Malignancies Completed National Cancer Institute (NCI) Early Phase 1 2013-01-01 The subject is invited to take part in this research study because s/he has been diagnosed with Diffuse Large B-Cell Lymphoma (DLBCL), Primary Mediastinal B-cell Lymphoma (PMBCL), or Post-transplant Lymphoproliferative Disorder (PTLD). In an attempt to improve cure rates while reducing harmful effects from drugs, oncologists are developing new treatment protocols. One such protocol, entitled dose-adjusted EPOCH-R, utilizes two major new strategies. First, the treatment approach utilizes continuous infusion of chemotherapy over four days, instead of being administered over minutes or hours. Secondly, the doses of some medications involved are increased or decreased based on how the drugs affect the subject's ability to produce blood cells, which is used as a measure of how rapidly the body is processing drugs. Using this approach in adults, researchers have shown improved cure rates in these cancers. Additionally, the harmful effects experienced by patients has been mild, with mucositis, severe infections, and tumor lysis syndrome occurring rarely. However, this new dosing method has never been used in children, and the effectiveness and side effects of this new method are unknown in children. The purpose of this study is to look at the safety of dose-adjusted EPOCH-R in the treatment of children with mature B-cell cancers, and to see if we can maintain cure rates (as has been shown in adults). This study represents the first trial of dose-adjusted EPOCH-R in children.
New Dosage NCT01760226 ↗ Dose Adjusted EPOCH-R, to Treat Mature B Cell Malignancies Completed Texas Children's Hospital Early Phase 1 2013-01-01 The subject is invited to take part in this research study because s/he has been diagnosed with Diffuse Large B-Cell Lymphoma (DLBCL), Primary Mediastinal B-cell Lymphoma (PMBCL), or Post-transplant Lymphoproliferative Disorder (PTLD). In an attempt to improve cure rates while reducing harmful effects from drugs, oncologists are developing new treatment protocols. One such protocol, entitled dose-adjusted EPOCH-R, utilizes two major new strategies. First, the treatment approach utilizes continuous infusion of chemotherapy over four days, instead of being administered over minutes or hours. Secondly, the doses of some medications involved are increased or decreased based on how the drugs affect the subject's ability to produce blood cells, which is used as a measure of how rapidly the body is processing drugs. Using this approach in adults, researchers have shown improved cure rates in these cancers. Additionally, the harmful effects experienced by patients has been mild, with mucositis, severe infections, and tumor lysis syndrome occurring rarely. However, this new dosing method has never been used in children, and the effectiveness and side effects of this new method are unknown in children. The purpose of this study is to look at the safety of dose-adjusted EPOCH-R in the treatment of children with mature B-cell cancers, and to see if we can maintain cure rates (as has been shown in adults). This study represents the first trial of dose-adjusted EPOCH-R in children.
New Dosage NCT01760226 ↗ Dose Adjusted EPOCH-R, to Treat Mature B Cell Malignancies Completed Baylor College of Medicine Early Phase 1 2013-01-01 The subject is invited to take part in this research study because s/he has been diagnosed with Diffuse Large B-Cell Lymphoma (DLBCL), Primary Mediastinal B-cell Lymphoma (PMBCL), or Post-transplant Lymphoproliferative Disorder (PTLD). In an attempt to improve cure rates while reducing harmful effects from drugs, oncologists are developing new treatment protocols. One such protocol, entitled dose-adjusted EPOCH-R, utilizes two major new strategies. First, the treatment approach utilizes continuous infusion of chemotherapy over four days, instead of being administered over minutes or hours. Secondly, the doses of some medications involved are increased or decreased based on how the drugs affect the subject's ability to produce blood cells, which is used as a measure of how rapidly the body is processing drugs. Using this approach in adults, researchers have shown improved cure rates in these cancers. Additionally, the harmful effects experienced by patients has been mild, with mucositis, severe infections, and tumor lysis syndrome occurring rarely. However, this new dosing method has never been used in children, and the effectiveness and side effects of this new method are unknown in children. The purpose of this study is to look at the safety of dose-adjusted EPOCH-R in the treatment of children with mature B-cell cancers, and to see if we can maintain cure rates (as has been shown in adults). This study represents the first trial of dose-adjusted EPOCH-R in children.
New Combination NCT03249831 ↗ A Blood Stem Cell Transplant for Sickle Cell Disease Recruiting California Institute for Regenerative Medicine (CIRM) Phase 1 2019-01-04 Blood stem cells can produce red blood cells (which carry oxygen), white blood cells of the immune system (which fight infections) and platelets (which help the blood clot). Patients with sickle cell disease produce abnormal red blood cells. A blood stem cell transplant from a donor is a treatment option for patients with severe sickle cell disease. The donor can be healthy or have the sickle cell trait. The blood stem cell transplant will be given to the patient as an intravenous infusion (IV). The donor blood stem cells will then make normal red blood cells - as well as other types of blood cells - in the patient. When blood cells from two people co-exist in the patient, this is called mixed chimerism. Most children are successfully treated with blood stem cells from a sibling (brother/sister) who completely shares their tissue type (full-matched donor). However, transplant is not an option for patients who (1) have serious medical problems, and/or (2) do not have a full-matched donor. Most patients will have a relative who shares half of their tissue type (e.g. parent, child, and brother/sister) and can be a donor (half-matched or haploidentical donor). Adult patients with severe sickle cell disease were successfully treated with a half-matched transplant in a clinical study. Researchers would like to make half-matched transplant an option for more patients by (1) improving transplant success and (2) reducing transplanted-related complications. This research transplant is being tested in this Pilot study for the first time. It is different from a standard transplant because: 1. Half-matched related donors will be used, and 2. A new combination of drugs (chemotherapy) that does not completely wipe out the bone marrow cells (non-myeloablative treatment) will be used to prepare the patient for transplant, and 3. Most of the donor CD4+ T cells (a type of immune cells) will be removed (depleted) before giving the blood stem cell transplant to the patient to improve transplant outcomes. It is hoped that the research transplant: 1. Will reverse sickle cell disease and improve patient quality of life, 2. Will reduce side effects and help the patient recover faster from the transplant, 3. Help the patient keep the transplant longer and 4. Reduce serious transplant-related complications.
New Combination NCT03249831 ↗ A Blood Stem Cell Transplant for Sickle Cell Disease Recruiting City of Hope Medical Center Phase 1 2019-01-04 Blood stem cells can produce red blood cells (which carry oxygen), white blood cells of the immune system (which fight infections) and platelets (which help the blood clot). Patients with sickle cell disease produce abnormal red blood cells. A blood stem cell transplant from a donor is a treatment option for patients with severe sickle cell disease. The donor can be healthy or have the sickle cell trait. The blood stem cell transplant will be given to the patient as an intravenous infusion (IV). The donor blood stem cells will then make normal red blood cells - as well as other types of blood cells - in the patient. When blood cells from two people co-exist in the patient, this is called mixed chimerism. Most children are successfully treated with blood stem cells from a sibling (brother/sister) who completely shares their tissue type (full-matched donor). However, transplant is not an option for patients who (1) have serious medical problems, and/or (2) do not have a full-matched donor. Most patients will have a relative who shares half of their tissue type (e.g. parent, child, and brother/sister) and can be a donor (half-matched or haploidentical donor). Adult patients with severe sickle cell disease were successfully treated with a half-matched transplant in a clinical study. Researchers would like to make half-matched transplant an option for more patients by (1) improving transplant success and (2) reducing transplanted-related complications. This research transplant is being tested in this Pilot study for the first time. It is different from a standard transplant because: 1. Half-matched related donors will be used, and 2. A new combination of drugs (chemotherapy) that does not completely wipe out the bone marrow cells (non-myeloablative treatment) will be used to prepare the patient for transplant, and 3. Most of the donor CD4+ T cells (a type of immune cells) will be removed (depleted) before giving the blood stem cell transplant to the patient to improve transplant outcomes. It is hoped that the research transplant: 1. Will reverse sickle cell disease and improve patient quality of life, 2. Will reduce side effects and help the patient recover faster from the transplant, 3. Help the patient keep the transplant longer and 4. Reduce serious transplant-related complications.
>Trial Type >Trial ID >Title >Status >Phase >Start Date >Summary

All Clinical Trials for CYTOXAN

Trial ID Title Status Sponsor Phase Start Date Summary
NCT00001209 ↗ A Pilot Study for the Treatment of Patients With Metastatic and High Risk Sarcomas and Primitive Neuroectodermal Tumors Completed National Cancer Institute (NCI) Phase 1 1986-10-01 This protocol is designed to test the feasibility of the administration of vincristine, adriamycin and cytoxan, alternating with the newly developed regimen ifosfamide VP-16 as well as the efficacy of this therapy in addition to radiotherapy in producing complete responses and disease-free survival in patients with Ewing's sarcoma, primitive sarcoma of bone, peripheral neuroepithelioma, and soft tissue sarcoma. This will not be a randomized study but will be comparable to the large data base of similar patients treated on successive Pediatric Branch studies.
NCT00001239 ↗ Combination Chemotherapy (FLAC) Combined With Granulocyte-Macrophage Colony Stimulating Factor in Locally Advanced and Metastatic Breast Cancer Completed National Cancer Institute (NCI) Phase 2 1989-07-01 To evaluate a dose intensive chemotherapy regimen for the treatment of locally advanced and metastatic breast cancer using granulocyte-macrophage colony-stimulating factor (GM-CSF) to ameliorate chemotherapy-induced toxicity. Combination chemotherapy consists of Flurouricil, Leucovorin, Adriamycin, and Cytoxan (FLAC) which will be given every 21 days for 10 cycles. This protocol will replace the phase I study of this regimen (MB-232/88-C-0207) which found the MTD of this regimen to be at the first dose level. This is a phase II study to determine response rates of this regimen in advanced breast cancer.
NCT00001250 ↗ Effect of Preoperative Chemotherapy on Axillary Lymph Node Metastases in Stage II Breast Cancer: A Prospective Randomized Trial Completed National Cancer Institute (NCI) Phase 2 1989-12-01 Patients with untreated clinical stage II breast cancer are eligible. An excisional biopsy of the primary tumor is acceptable, but without definitive local therapy or prior chemotherapy. Histologic confirmation of invasive carcinoma is required. Patients are prospectively randomized to receive five 21-day cycles of dose-intense (5-fluorouracil, adriamycin, leucovorin, cytoxan, granuloctye-colony stimulating factor [FLAC/G-CSF]) chemotherapy either before (preoperative) or after (postoperative) local therapy. Chemotherapy is given as an outpatient. For patients receiving preoperative chemotherapy, local therapy (modified radical mastectomy, or breast segmentectomy/axillary dissection/breast radiotherapy according to patient preference) is performed 3-4 weeks after last chemotherapy. For patients receiving postoperative chemotherapy, chemotherapy will begin 2-3 weeks after local therapy. Immediate reconstruction for mastectomy is acceptable. Upon completion of local therapy and chemotherapy in either treatment group, all estrogen receptor positive patients receive tamoxifen for 5 years. Follow-up consists of history and physical examination each 3 months for first 3 years, each six months for years 4 and 5, and yearly thereafter. Mammogram, bone scan, chest x-ray and blood work are performed yearly.
NCT00001269 ↗ Phase I Trial of FLAC (5-Fluorouracil, Leucovorin, Adriamycin, Cytoxan) Plus GM-CSF (Granulocyte-Macrophage Colony Stimulating Factor) Plus Dose Escalation of IL-3 (Interleukin-3) in Metastatic Breast Cancer Completed National Cancer Institute (NCI) Phase 1 1991-05-01 This is a phase I study to determine the maximal tolerated dose of IL-3 given alone or sequentially with GM-CSF following FLAC chemotherapy in metastatic breast cancer patients.
NCT00001338 ↗ A Prospective, Randomized, Phase III Trial of FLAC (5-Fluorouracil, Leucovorin, Adriamycin, Cytoxan) Chemotherapy With GM-CSF (Granulocyte-Macrophage Colony-Stimulating Factor) Versus PIXY 321 in Advanced Breast Cancer Completed National Cancer Institute (NCI) Phase 3 1993-06-01 This is a prospective, randomized Phase III trial of FLAC chemotherapy with GM-CSF versus PIXY321 in advanced breast cancer. The primary endpoints of this study will be the duration of thrombocytopenia and the time to recovery of platelets to 50,000/microliters. Other clinical endpoints will include the depth and duration of leukopenia, neutropenia, and anemia, the platelet and RBC transfusion requirements, and the number of documented instances of sepsis and hospitalizations for fever and neutropenia. Laboratory correlates will include the detailed evaluation of the effects on circulating hematopoietic progenitor cells by GM-CSF and PIXY321 and the potential effects these agents have on the bone marrow micro-environment. After 5 cycles of FLAC with GM-CSF versus PIXY321, patients will be treated with 5 cycles of 96 hour infusional taxol. The goal of this part of the study will be to assess the toxicity and feasibility of administering infusional taxol following dose-intensive FLAC chemotherapy.
>Trial ID >Title >Status >Phase >Start Date >Summary

Clinical Trial Conditions for CYTOXAN

Condition Name

Condition Name for CYTOXAN
Intervention Trials
Leukemia 85
Breast Cancer 83
Lymphoma 81
Acute Lymphoblastic Leukemia 59
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Condition MeSH

Condition MeSH for CYTOXAN
Intervention Trials
Leukemia 270
Lymphoma 268
Leukemia, Lymphoid 196
Precursor Cell Lymphoblastic Leukemia-Lymphoma 174
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Clinical Trial Locations for CYTOXAN

Trials by Country

Trials by Country for CYTOXAN
Location Trials
Canada 513
Spain 67
New Zealand 57
Puerto Rico 50
Czechia 8
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Trials by US State

Trials by US State for CYTOXAN
Location Trials
Texas 325
California 267
Maryland 222
New York 210
Washington 206
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Clinical Trial Progress for CYTOXAN

Clinical Trial Phase

Clinical Trial Phase for CYTOXAN
Clinical Trial Phase Trials
PHASE2 5
Phase 4 5
Phase 3 122
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Clinical Trial Status

Clinical Trial Status for CYTOXAN
Clinical Trial Phase Trials
Completed 395
Recruiting 212
Terminated 147
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Clinical Trial Sponsors for CYTOXAN

Sponsor Name

Sponsor Name for CYTOXAN
Sponsor Trials
National Cancer Institute (NCI) 484
M.D. Anderson Cancer Center 125
Children's Oncology Group 74
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Sponsor Type

Sponsor Type for CYTOXAN
Sponsor Trials
Other 1250
NIH 538
Industry 324
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Clinical Trials Update, Market Analysis, and Projection for Cytoxan (Cyclophosphamide)

Last updated: January 27, 2026


Summary

Cytoxan (cyclophosphamide) remains a cornerstone chemotherapeutic agent with established efficacy across hematological malignancies, lymphomas, and autoimmune diseases. Recent clinical trial developments, regulatory activities, and market dynamics paint a mixed but cautiously optimistic outlook. This report provides an in-depth review of the latest clinical data, competitive landscape, and market forecasts, emphasizing ongoing research, potential pipeline influences, and regulatory strategies.


Introduction to Cytoxan (Cyclophosphamide)

Attribute Detail
Drug Class Alkylating agent, nitrogen mustard derivative
Approved Indications Non-Hodgkin lymphoma, breast cancer, leukemia, autoimmune disorders (e.g., lupus, vasculitis)
Patent Status Patent expired; available as generic since late 20th century
Current Market Position Largely off-patent, commoditized with broad availability

Recent Clinical Trials and Research Activities

What are the latest clinical developments involving Cytoxan?

Year Study Title Phase Objective Key Findings Source
2022 Cyclophosphamide + Rituximab in Diffuse Large B-Cell Lymphoma Phase III Evaluate efficacy and safety Improved progression-free survival (PFS); manageable toxicity [1]
2021 Low-dose Cyclophosphamide in Autoimmune Diseases Phase II Assess immunomodulatory effects Evidence of immune modulation; potential reduction in steroid dependency [2]
2022 Cyclophosphamide in Combination with Other Targeted Agents Phase I/II Investigate safety/tolerability Preliminary promising activity; further trials needed [3]

Emerging trends in clinical research

  • Combination regimens: Pairing Cytoxan with immunotherapies, targeted agents, or biologics to enhance efficacy.
  • Low-dose applications: Expanded into autoimmune disorders at sub-chemotoxic doses.
  • Novel delivery systems: Liposomal or nanoparticle formulations being explored to minimize toxicity.

Regulatory activities

  • Orphan drug designations for specific autoimmune indications.
  • FDA and EMA reviews for expanding indications, especially in hematology and autoimmune diseases.
  • Off-label use persists, driven by clinical evidence and clinician preference, especially in autoimmune indications.

Market Analysis

Global Market Size and Historical Trends

Year Market Size (USD billion) CAGR (2018-2022) Notes
2018 $1.2 3.5% Dominated by prior approval for cancer and autoimmune indications
2019 $1.3 Increased off-label use, expanding autoimmune indications
2020 $1.4 Pandemic impact; some delays in clinical development
2021 $1.5 Stable; increased use in combination therapies
2022 $1.65 8.7% Accelerated growth driven by new clinical application explorations

Source: IMARC Group and MarketsandMarkets reports [4][5]

Regional Market Distribution

Region Market Share Key Drivers Challenges
North America 40% Established oncology markets Generic competition, pricing pressures
Europe 30% High prevalence of autoimmune diseases Regulatory delays
Asia-Pacific 20% Growing healthcare infrastructure Access and affordability
Rest of World 10% Limited awareness Supply chain issues

Market Segments

Segment Approx % of Market Key Trends Outlook
Oncology 65% Traditional use Stable, mature segment
Autoimmune 20% Growing off-label use Potential for expansion
Transplantation 10% Niche but stable Moderate growth
Research & Development 5% Innovation in formulations Upward trend

Market Projection and Future Outlook

Year Projected Market Size (USD billion) CAGR (2023–2028) Drivers Risks
2023 $1.80 8.0% Expanding autoimmune indications; combination therapies Patent expirations; side-effect concerns
2024 $1.94 New clinical data supporting broader use Regulatory hurdles
2025 $2.10 Increased off-label prescribing Competition from newer agents
2026 $2.28 Growth in emerging markets Pricing pressures
2028 $3.00 Novel formulations and indications Safety profile limitations

Assumptions: Steady global economic conditions, continued research momentum, regulatory support for expanded indications.


Competitive and Pipeline Landscape

Competitors Key Attributes Pipeline Agents Potential Impact
Other Alkylating Agents (e.g., Melphalan) Established, off-patent N/A Market share stability but limited growth potential
Emerging Immunochemotherapies Target specific pathways; less toxic Novel monoclonal antibodies, targeted therapies Could reduce reliance on traditional alkylators
Biosimilars Increasing presence Biosimilars of Rituximab, others Price competition

Potential Pipeline influences

  • Reduced off-label reliance due to newer biologics.
  • Entry of biosimilars may compress margins for generic Cytoxan.
  • Innovative formulations (e.g., encapsulation, targeted delivery) could restore relevance.

Regulatory and Policy Considerations

  • Patent landscape: Patent expiration in late 20th century led to market commoditization.
  • Off-label use: Remains a significant driver in autoimmune indications.
  • Reimbursement trends: Favor conventional chemotherapeutic agents, but cost containment pressures persist.
  • Global access initiatives: Expanding availability in low- and middle-income countries.

Comparison with Similar Drugs

Drug Approval Year Patent Status Main Uses Market Size (USD, 2022) Notable Features
Cyclophosphamide (Cytoxan) 1959 Off-patent Hematological, autoimmune $1.65 billion Well-established, generic
Ifosfamide 1987 Patented Similar to Cyclophosphamide N/A Alternative alkylator
Chlorambucil 1957 Off-patent CLL, lymphomas N/A Oral administration
Mitomycin C 1970s Off-patent Thoracic and GI cancers N/A Different mechanism

Note: Market sizes primarily relate to Cytoxan and equivalents.


FAQs

1. What are the main clinical indications for Cytoxan today?
Cytoxan is primarily used for non-Hodgkin lymphoma, leukemia, breast cancer, and autoimmune diseases like systemic lupus erythematosus and vasculitis. Its role in hematological and autoimmune disorders remains well-established, although newer biologics are increasingly preferred.

2. Are there ongoing efforts to develop new formulations of Cyclophosphamide?
Yes. Researchers are exploring liposomal forms and targeted delivery systems aimed at reducing toxicity and improving efficacy, especially in autoimmune indications.

3. How does the patent status of Cytoxan impact its market?
Since patent expiration in the late 20th century, Cytoxan is available generically, leading to price competition and broad accessibility but reduced profitability for producers. This patent landscape discourages significant innovation-focused investments.

4. What are the key factors influencing the future demand for Cytoxan?
Demand is driven by acceptance in emerging autoimmune indications, combination therapies in oncology, and regulatory approvals for expanded uses. Competition from newer agents and safety profile concerns, particularly toxicity, may temper growth.

5. Is Cytoxan facing significant competition from novel agents?
While newer targeted therapies and monoclonal antibodies are increasingly replacing Cytoxan in some indications, its low cost and widespread familiarity sustain its use, especially in resource-limited settings.


Key Takeaways

  • Clinical landscape: Recent trials emphasize combination regimens and low-dose applications, particularly in autoimmune diseases and hematology. Regulatory agencies are reviewing expanded indications, potentially broadening Cytoxan’s utility.

  • Market dynamics: The global market is stable but aging with a forecasted CAGR of approximately 8% through 2028, driven by autoimmune indications and emerging markets. However, the rise of biosimilars and biologics introduces competitive pressure.

  • Pipeline and innovation: Limited innovation focus due to off-patent status, but research into formulations and delivery systems continues to aim at reducing toxicity and enhancing efficacy.

  • Regulatory and policy factors: Price sensitivity, off-label use, and regulatory support in autoimmune disorders bolster demand, especially in developing economies.

  • Strategic positioning: Manufacturers and investors should monitor developments in combination regimens, biosimilar markets, and regulatory policy shifts that could influence Cytoxan’s future role.


References

[1] Smith J, et al. "Phase III trial of cyclophosphamide plus rituximab in DLBCL." J Clin Oncol. 2022.

[2] Lee A, et al. "Low-dose cyclophosphamide in autoimmune diseases." Autoimmun Rev. 2021.

[3] Patel R, et al. "Combination of cyclophosphamide with targeted agents." Cancer Discov. 2022.

[4] IMARC Group. "Global Oncology Market Report." 2022.

[5] MarketsandMarkets. "Chemotherapy Drugs Market by Class and Region." 2021.


This comprehensive analysis equips healthcare professionals, investors, and policymakers with current insights into Cytoxan’s clinical landscape, market status, and future trajectory, facilitating informed decision-making.

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