Acute pancreatitis is an uncommon but serious complication of cancer chemotherapy. A 16-year-old girl with metastatic osteosarcoma experienced recurrent bouts of symptomatic pancreatitis 24 hours after treatment with ifosfamide administered as a single agent. To the authors' knowledge, this is the first report of an association between ifosfamide and pancreatitis. Because serum amylase levels are not monitored routinely during treatment with most chemotherapeutic agents, subclinical cases of pancreatitis with ifosfamide and other agents may go undetected.