Difference between revisions of "Ewing sarcoma, pediatric"
Jump to navigation
Jump to search
Wayneliang (talk | contribs) m (changed regimen name) Tag: visualeditor |
|||
| Line 6: | Line 6: | ||
|} | |} | ||
{{TOC limit|limit=4}} | {{TOC limit|limit=4}} | ||
| − | |||
=Upfront Therapy= | =Upfront Therapy= | ||
| − | == | + | ==COG AEWS0031== |
===Regimen A Induction=== | ===Regimen A Induction=== | ||
*Regimen A is a standard regimen consisting of 21 day cycles | *Regimen A is a standard regimen consisting of 21 day cycles | ||
| Line 18: | Line 17: | ||
*[[Cyclophosphamide (Cytoxan)]] 1200 mg/m<sup>2</sup> IV over 1 hour on Days 1 | *[[Cyclophosphamide (Cytoxan)]] 1200 mg/m<sup>2</sup> IV over 1 hour on Days 1 | ||
**Treat with 50% doses calculated on a m<sup>2</sup> basis for children < 1 year, then consider increasing to 75% and then to 100 % of calculated dose if tolerated | **Treat with 50% doses calculated on a m<sup>2</sup> basis for children < 1 year, then consider increasing to 75% and then to 100 % of calculated dose if tolerated | ||
| − | *[[Mesna (Mesnex)]] 720 mg/m<sup>2</sup> IV continuous infusion on day 1 | + | *[[Mesna (Mesnex)]] 720 mg/m<sup>2</sup> IV continuous infusion on day 1 |
**NOTE: Protocol states that [[Mesna (Mesnex)]] should be dosed as AT LEAST 60% of [[Cyclophosphamide (Cytoxan)]] m<sup>2</sup> | **NOTE: Protocol states that [[Mesna (Mesnex)]] should be dosed as AT LEAST 60% of [[Cyclophosphamide (Cytoxan)]] m<sup>2</sup> | ||
**[[Mesna (Mesnex)]] continuous infusion should be started at the same time as the [[Cyclophosphamide (Cytoxan)]] and remain until at least 8 hours after the end of the [[Cyclophosphamide (Cytoxan)]] infusion | **[[Mesna (Mesnex)]] continuous infusion should be started at the same time as the [[Cyclophosphamide (Cytoxan)]] and remain until at least 8 hours after the end of the [[Cyclophosphamide (Cytoxan)]] infusion | ||
| − | *[[Filgrastim (Neupogen)]] 5 mcg/kg SC for at least 7 days, or until ANC ≥ 750/μl, beginning on day 2 | + | *[[Filgrastim (Neupogen)]] 5 mcg/kg SC for at least 7 days, or until ANC ≥ 750/μl, beginning on day 2 |
**ANC ≥ 750/μl on or before day 7 of the cycle is not sufficient for discontinuing G-CSF | **ANC ≥ 750/μl on or before day 7 of the cycle is not sufficient for discontinuing G-CSF | ||
| − | |||
'''21 day cycle''' | '''21 day cycle''' | ||
| − | |||
====Cycles 2 & 4 (IE)==== | ====Cycles 2 & 4 (IE)==== | ||
*[[Ifosfamide (Ifex)]] 1800 mg/m<sup>2</sup> IV infusion over 1 hour once on day 1 to 5 | *[[Ifosfamide (Ifex)]] 1800 mg/m<sup>2</sup> IV infusion over 1 hour once on day 1 to 5 | ||
| Line 31: | Line 28: | ||
*[[Etoposide (Vepesid)]] 100 mg/m<sup>2</sup> IV infusion over 1 to 2 hours once on days 1 to 5 | *[[Etoposide (Vepesid)]] 100 mg/m<sup>2</sup> IV infusion over 1 to 2 hours once on days 1 to 5 | ||
**Treat with 50% doses calculated on a m<sup>2</sup> basis for children < 1 year, then consider increasing to 75% and then to 100 % of calculated dose if tolerated | **Treat with 50% doses calculated on a m<sup>2</sup> basis for children < 1 year, then consider increasing to 75% and then to 100 % of calculated dose if tolerated | ||
| − | *[[Mesna (Mesnex)]] 1080 mg/m<sup>2</sup> IV continuous infusion on day 1 | + | *[[Mesna (Mesnex)]] 1080 mg/m<sup>2</sup> IV continuous infusion on day 1 |
**NOTE: Protocol states that [[Mesna (Mesnex)]] should be dosed as AT LEAST 60% of [[Ifosfamide (Ifex)]] m<sup>2</sup> | **NOTE: Protocol states that [[Mesna (Mesnex)]] should be dosed as AT LEAST 60% of [[Ifosfamide (Ifex)]] m<sup>2</sup> | ||
**[[Mesna (Mesnex)]] continuous infusion should be started at the same time as the [[Ifosfamide (Ifex)]] and remain until at least 8 hours after the end of the [[Ifosfamide (Ifex)]] infusion | **[[Mesna (Mesnex)]] continuous infusion should be started at the same time as the [[Ifosfamide (Ifex)]] and remain until at least 8 hours after the end of the [[Ifosfamide (Ifex)]] infusion | ||
*[[Filgrastim (Neupogen)]] 5 mcg/kg SC for at least 7 days, or until ANC ≥ 750/μl, beginning on day 6 | *[[Filgrastim (Neupogen)]] 5 mcg/kg SC for at least 7 days, or until ANC ≥ 750/μl, beginning on day 6 | ||
**ANC ≥ 750/μl on or before day 7 of the cycle is not sufficient for discontinuing G-CSF | **ANC ≥ 750/μl on or before day 7 of the cycle is not sufficient for discontinuing G-CSF | ||
| − | |||
'''21 day cycle''' | '''21 day cycle''' | ||
| − | |||
===Regimen A Continuation=== | ===Regimen A Continuation=== | ||
*At week 13 patients either underwent surgery, received radiation, or both | *At week 13 patients either underwent surgery, received radiation, or both | ||
| Line 44: | Line 39: | ||
====Cycle 5 & 9 (VDC)==== | ====Cycle 5 & 9 (VDC)==== | ||
Cycle 5 begins on week 15 in patients receiving surgery and on week 13 in Regimen A<sub>2</sub> | Cycle 5 begins on week 15 in patients receiving surgery and on week 13 in Regimen A<sub>2</sub> | ||
| − | |||
*[[Vincristine (Oncovin)]] 2 mg/m<sup>2</sup> IV push once on day 1 (maximum dose of 2 mg) | *[[Vincristine (Oncovin)]] 2 mg/m<sup>2</sup> IV push once on day 1 (maximum dose of 2 mg) | ||
**Treat with 50% doses calculated on a m<sup>2</sup> basis for children < 1 year, then consider increasing to 75% and then to 100 % of calculated dose if tolerated | **Treat with 50% doses calculated on a m<sup>2</sup> basis for children < 1 year, then consider increasing to 75% and then to 100 % of calculated dose if tolerated | ||
| Line 51: | Line 45: | ||
*[[Cyclophosphamide (Cytoxan)]] 1200 mg/m<sup>2</sup> IV over 1 hour on Days 1 | *[[Cyclophosphamide (Cytoxan)]] 1200 mg/m<sup>2</sup> IV over 1 hour on Days 1 | ||
**Treat with 50% doses calculated on a m<sup>2</sup> basis for children < 1 year, then consider increasing to 75% and then to 100 % of calculated dose if tolerated | **Treat with 50% doses calculated on a m<sup>2</sup> basis for children < 1 year, then consider increasing to 75% and then to 100 % of calculated dose if tolerated | ||
| − | *[[Mesna (Mesnex)]] 720 mg/m<sup>2</sup> IV continuous infusion on day 1 | + | *[[Mesna (Mesnex)]] 720 mg/m<sup>2</sup> IV continuous infusion on day 1 |
**NOTE: Protocol states that [[Mesna (Mesnex)]] should be dosed as AT LEAST 60% of [[Cyclophosphamide (Cytoxan)]] m<sup>2</sup> | **NOTE: Protocol states that [[Mesna (Mesnex)]] should be dosed as AT LEAST 60% of [[Cyclophosphamide (Cytoxan)]] m<sup>2</sup> | ||
**[[Mesna (Mesnex)]] continuous infusion should be started at the same time as the [[Cyclophosphamide (Cytoxan)]] and remain until at least 8 hours after the end of the [[Cyclophosphamide (Cytoxan)]] infusion | **[[Mesna (Mesnex)]] continuous infusion should be started at the same time as the [[Cyclophosphamide (Cytoxan)]] and remain until at least 8 hours after the end of the [[Cyclophosphamide (Cytoxan)]] infusion | ||
| − | *[[Filgrastim (Neupogen)]] 5 mcg/kg SC for at least 7 days, or until ANC ≥ 750/μl, beginning on day 2 | + | *[[Filgrastim (Neupogen)]] 5 mcg/kg SC for at least 7 days, or until ANC ≥ 750/μl, beginning on day 2 |
**ANC ≥ 750/μl on or before day 7 of the cycle is not sufficient for discontinuing G-CSF | **ANC ≥ 750/μl on or before day 7 of the cycle is not sufficient for discontinuing G-CSF | ||
| − | |||
'''21 day cycle''' | '''21 day cycle''' | ||
| − | |||
====Cycle 6, 8, 10, 12, & 14 (IE)==== | ====Cycle 6, 8, 10, 12, & 14 (IE)==== | ||
*[[Ifosfamide (Ifex)]] 1800 mg/m<sup>2</sup> IV infusion over 1 hour once on day 1 to 5 | *[[Ifosfamide (Ifex)]] 1800 mg/m<sup>2</sup> IV infusion over 1 hour once on day 1 to 5 | ||
| Line 64: | Line 56: | ||
*[[Etoposide (Vepesid)]] 100 mg/m<sup>2</sup> IV infusion over 1 to 2 hours once on days 1 to 5 | *[[Etoposide (Vepesid)]] 100 mg/m<sup>2</sup> IV infusion over 1 to 2 hours once on days 1 to 5 | ||
**Treat with 50% doses calculated on a m<sup>2</sup> basis for children < 1 year, then consider increasing to 75% and then to 100 % of calculated dose if tolerated | **Treat with 50% doses calculated on a m<sup>2</sup> basis for children < 1 year, then consider increasing to 75% and then to 100 % of calculated dose if tolerated | ||
| − | *[[Mesna (Mesnex)]] 1080 mg/m<sup>2</sup> IV continuous infusion on day 1 | + | *[[Mesna (Mesnex)]] 1080 mg/m<sup>2</sup> IV continuous infusion on day 1 |
**NOTE: Protocol states that [[Mesna (Mesnex)]] should be dosed as AT LEAST 60% of [[Ifosfamide (Ifex)]] m<sup>2</sup> | **NOTE: Protocol states that [[Mesna (Mesnex)]] should be dosed as AT LEAST 60% of [[Ifosfamide (Ifex)]] m<sup>2</sup> | ||
**[[Mesna (Mesnex)]] continuous infusion should be started at the same time as the [[Ifosfamide (Ifex)]] and remain until at least 8 hours after the end of the [[Ifosfamide (Ifex)]] infusion | **[[Mesna (Mesnex)]] continuous infusion should be started at the same time as the [[Ifosfamide (Ifex)]] and remain until at least 8 hours after the end of the [[Ifosfamide (Ifex)]] infusion | ||
*[[Filgrastim (Neupogen)]] 5 mcg/kg SC for at least 7 days, or until ANC ≥ 750/μl, beginning on day 6 | *[[Filgrastim (Neupogen)]] 5 mcg/kg SC for at least 7 days, or until ANC ≥ 750/μl, beginning on day 6 | ||
**ANC ≥ 750/μl on or before day 7 of the cycle is not sufficient for discontinuing G-CSF | **ANC ≥ 750/μl on or before day 7 of the cycle is not sufficient for discontinuing G-CSF | ||
| − | |||
'''21 day cycle''' | '''21 day cycle''' | ||
| − | |||
====Cycle 7 (VDC) Regimen A<sub>1</sub> (Surgery Only)==== | ====Cycle 7 (VDC) Regimen A<sub>1</sub> (Surgery Only)==== | ||
*[[Vincristine (Oncovin)]] 2 mg/m<sup>2</sup> IV push once on day 1 (maximum dose of 2 mg) | *[[Vincristine (Oncovin)]] 2 mg/m<sup>2</sup> IV push once on day 1 (maximum dose of 2 mg) | ||
| Line 79: | Line 69: | ||
*[[Cyclophosphamide (Cytoxan)]] 1200 mg/m<sup>2</sup> IV over 1 hour on Days 1 | *[[Cyclophosphamide (Cytoxan)]] 1200 mg/m<sup>2</sup> IV over 1 hour on Days 1 | ||
**Treat with 50% doses calculated on a m<sup>2</sup> basis for children < 1 year, then consider increasing to 75% and then to 100 % of calculated dose if tolerated | **Treat with 50% doses calculated on a m<sup>2</sup> basis for children < 1 year, then consider increasing to 75% and then to 100 % of calculated dose if tolerated | ||
| − | *[[Mesna (Mesnex)]] 720 mg/m<sup>2</sup> IV continuous infusion on day 1 | + | *[[Mesna (Mesnex)]] 720 mg/m<sup>2</sup> IV continuous infusion on day 1 |
**NOTE: Protocol states that [[Mesna (Mesnex)]] should be dosed as AT LEAST 60% of [[Cyclophosphamide (Cytoxan)]] m<sup>2</sup> | **NOTE: Protocol states that [[Mesna (Mesnex)]] should be dosed as AT LEAST 60% of [[Cyclophosphamide (Cytoxan)]] m<sup>2</sup> | ||
**[[Mesna (Mesnex)]] continuous infusion should be started at the same time as the [[Cyclophosphamide (Cytoxan)]] and remain until at least 8 hours after the end of the [[Cyclophosphamide (Cytoxan)]] infusion | **[[Mesna (Mesnex)]] continuous infusion should be started at the same time as the [[Cyclophosphamide (Cytoxan)]] and remain until at least 8 hours after the end of the [[Cyclophosphamide (Cytoxan)]] infusion | ||
| − | *[[Filgrastim (Neupogen)]] 5 mcg/kg SC for at least 7 days, or until ANC ≥ 750/μl, beginning on day 2 | + | *[[Filgrastim (Neupogen)]] 5 mcg/kg SC for at least 7 days, or until ANC ≥ 750/μl, beginning on day 2 |
**ANC ≥ 750/μl on or before day 7 of the cycle is not sufficient for discontinuing G-CSF | **ANC ≥ 750/μl on or before day 7 of the cycle is not sufficient for discontinuing G-CSF | ||
| − | |||
'''21 day cycle''' | '''21 day cycle''' | ||
| − | |||
====Cycle 7 (VC) Regimen A<sub>2</sub> & A<sub>3</sub> (Radiation w/ or w/o Surgery)==== | ====Cycle 7 (VC) Regimen A<sub>2</sub> & A<sub>3</sub> (Radiation w/ or w/o Surgery)==== | ||
*[[Vincristine (Oncovin)]] 2 mg/m<sup>2</sup> IV push once on day 1 (maximum dose of 2 mg) | *[[Vincristine (Oncovin)]] 2 mg/m<sup>2</sup> IV push once on day 1 (maximum dose of 2 mg) | ||
| Line 92: | Line 80: | ||
*[[Cyclophosphamide (Cytoxan)]] 1200 mg/m<sup>2</sup> IV over 1 hour on Days 1 | *[[Cyclophosphamide (Cytoxan)]] 1200 mg/m<sup>2</sup> IV over 1 hour on Days 1 | ||
**Treat with 50% doses calculated on a m<sup>2</sup> basis for children < 1 year, then consider increasing to 75% and then to 100 % of calculated dose if tolerated | **Treat with 50% doses calculated on a m<sup>2</sup> basis for children < 1 year, then consider increasing to 75% and then to 100 % of calculated dose if tolerated | ||
| − | *[[Mesna (Mesnex)]] 720 mg/m<sup>2</sup> IV continuous infusion on day 1 | + | *[[Mesna (Mesnex)]] 720 mg/m<sup>2</sup> IV continuous infusion on day 1 |
**NOTE: Protocol states that [[Mesna (Mesnex)]] should be dosed as AT LEAST 60% of [[Cyclophosphamide (Cytoxan)]] m<sup>2</sup> | **NOTE: Protocol states that [[Mesna (Mesnex)]] should be dosed as AT LEAST 60% of [[Cyclophosphamide (Cytoxan)]] m<sup>2</sup> | ||
**[[Mesna (Mesnex)]] continuous infusion should be started at the same time as the [[Cyclophosphamide (Cytoxan)]] and remain until at least 8 hours after the end of the [[Cyclophosphamide (Cytoxan)]] infusion | **[[Mesna (Mesnex)]] continuous infusion should be started at the same time as the [[Cyclophosphamide (Cytoxan)]] and remain until at least 8 hours after the end of the [[Cyclophosphamide (Cytoxan)]] infusion | ||
| − | *[[Filgrastim (Neupogen)]] 5 mcg/kg SC for at least 7 days, or until ANC ≥ 750/μl, beginning on day 2 | + | *[[Filgrastim (Neupogen)]] 5 mcg/kg SC for at least 7 days, or until ANC ≥ 750/μl, beginning on day 2 |
**ANC ≥ 750/μl on or before day 7 of the cycle is not sufficient for discontinuing G-CSF | **ANC ≥ 750/μl on or before day 7 of the cycle is not sufficient for discontinuing G-CSF | ||
| − | |||
'''21 day cycle''' | '''21 day cycle''' | ||
| − | |||
====Cycle 11 (VC) Regimen A<sub>1</sub> (Surgery Only)==== | ====Cycle 11 (VC) Regimen A<sub>1</sub> (Surgery Only)==== | ||
*[[Vincristine (Oncovin)]] 2 mg/m<sup>2</sup> IV push once on day 1 (maximum dose of 2 mg) | *[[Vincristine (Oncovin)]] 2 mg/m<sup>2</sup> IV push once on day 1 (maximum dose of 2 mg) | ||
| Line 105: | Line 91: | ||
*[[Cyclophosphamide (Cytoxan)]] 1200 mg/m<sup>2</sup> IV over 1 hour on Days 1 | *[[Cyclophosphamide (Cytoxan)]] 1200 mg/m<sup>2</sup> IV over 1 hour on Days 1 | ||
**Treat with 50% doses calculated on a m<sup>2</sup> basis for children < 1 year, then consider increasing to 75% and then to 100 % of calculated dose if tolerated | **Treat with 50% doses calculated on a m<sup>2</sup> basis for children < 1 year, then consider increasing to 75% and then to 100 % of calculated dose if tolerated | ||
| − | *[[Mesna (Mesnex)]] 720 mg/m<sup>2</sup> IV continuous infusion on day 1 | + | *[[Mesna (Mesnex)]] 720 mg/m<sup>2</sup> IV continuous infusion on day 1 |
**NOTE: Protocol states that [[Mesna (Mesnex)]] should be dosed as AT LEAST 60% of [[Cyclophosphamide (Cytoxan)]] m<sup>2</sup> | **NOTE: Protocol states that [[Mesna (Mesnex)]] should be dosed as AT LEAST 60% of [[Cyclophosphamide (Cytoxan)]] m<sup>2</sup> | ||
**[[Mesna (Mesnex)]] continuous infusion should be started at the same time as the [[Cyclophosphamide (Cytoxan)]] and remain until at least 8 hours after the end of the [[Cyclophosphamide (Cytoxan)]] infusion | **[[Mesna (Mesnex)]] continuous infusion should be started at the same time as the [[Cyclophosphamide (Cytoxan)]] and remain until at least 8 hours after the end of the [[Cyclophosphamide (Cytoxan)]] infusion | ||
| − | *[[Filgrastim (Neupogen)]] 5 mcg/kg SC for at least 7 days, or until ANC ≥ 750/μl, beginning on day 2 | + | *[[Filgrastim (Neupogen)]] 5 mcg/kg SC for at least 7 days, or until ANC ≥ 750/μl, beginning on day 2 |
**ANC ≥ 750/μl on or before day 7 of the cycle is not sufficient for discontinuing G-CSF | **ANC ≥ 750/μl on or before day 7 of the cycle is not sufficient for discontinuing G-CSF | ||
| − | |||
'''21 day cycle''' | '''21 day cycle''' | ||
| − | |||
====Cycle 11 (VDC) Regimen A<sub>2</sub> & A<sub>3</sub> (Radiation w/ or w/o Surgery)==== | ====Cycle 11 (VDC) Regimen A<sub>2</sub> & A<sub>3</sub> (Radiation w/ or w/o Surgery)==== | ||
*[[Vincristine (Oncovin)]] 2 mg/m<sup>2</sup> IV push once on day 1 (maximum dose of 2 mg) | *[[Vincristine (Oncovin)]] 2 mg/m<sup>2</sup> IV push once on day 1 (maximum dose of 2 mg) | ||
| Line 120: | Line 104: | ||
*[[Cyclophosphamide (Cytoxan)]] 1200 mg/m<sup>2</sup> IV over 1 hour on Days 1 | *[[Cyclophosphamide (Cytoxan)]] 1200 mg/m<sup>2</sup> IV over 1 hour on Days 1 | ||
**Treat with 50% doses calculated on a m<sup>2</sup> basis for children < 1 year, then consider increasing to 75% and then to 100 % of calculated dose if tolerated | **Treat with 50% doses calculated on a m<sup>2</sup> basis for children < 1 year, then consider increasing to 75% and then to 100 % of calculated dose if tolerated | ||
| − | *[[Mesna (Mesnex)]] 720 mg/m<sup>2</sup> IV continuous infusion on day 1 | + | *[[Mesna (Mesnex)]] 720 mg/m<sup>2</sup> IV continuous infusion on day 1 |
**NOTE: Protocol states that [[Mesna (Mesnex)]] should be dosed as AT LEAST 60% of [[Cyclophosphamide (Cytoxan)]] m<sup>2</sup> | **NOTE: Protocol states that [[Mesna (Mesnex)]] should be dosed as AT LEAST 60% of [[Cyclophosphamide (Cytoxan)]] m<sup>2</sup> | ||
**[[Mesna (Mesnex)]] continuous infusion should be started at the same time as the [[Cyclophosphamide (Cytoxan)]] and remain until at least 8 hours after the end of the [[Cyclophosphamide (Cytoxan)]] infusion | **[[Mesna (Mesnex)]] continuous infusion should be started at the same time as the [[Cyclophosphamide (Cytoxan)]] and remain until at least 8 hours after the end of the [[Cyclophosphamide (Cytoxan)]] infusion | ||
| − | *[[Filgrastim (Neupogen)]] 5 mcg/kg SC for at least 7 days, or until ANC ≥ 750/μl, beginning on day 2 | + | *[[Filgrastim (Neupogen)]] 5 mcg/kg SC for at least 7 days, or until ANC ≥ 750/μl, beginning on day 2 |
**ANC ≥ 750/μl on or before day 7 of the cycle is not sufficient for discontinuing G-CSF | **ANC ≥ 750/μl on or before day 7 of the cycle is not sufficient for discontinuing G-CSF | ||
| − | |||
'''21 day cycle''' | '''21 day cycle''' | ||
| − | |||
====Cycle 13 (VC)==== | ====Cycle 13 (VC)==== | ||
*[[Vincristine (Oncovin)]] 2 mg/m<sup>2</sup> IV push once on day 1 (maximum dose of 2 mg) | *[[Vincristine (Oncovin)]] 2 mg/m<sup>2</sup> IV push once on day 1 (maximum dose of 2 mg) | ||
| Line 133: | Line 115: | ||
*[[Cyclophosphamide (Cytoxan)]] 1200 mg/m<sup>2</sup> IV over 1 hour on Days 1 | *[[Cyclophosphamide (Cytoxan)]] 1200 mg/m<sup>2</sup> IV over 1 hour on Days 1 | ||
**Treat with 50% doses calculated on a m<sup>2</sup> basis for children < 1 year, then consider increasing to 75% and then to 100 % of calculated dose if tolerated | **Treat with 50% doses calculated on a m<sup>2</sup> basis for children < 1 year, then consider increasing to 75% and then to 100 % of calculated dose if tolerated | ||
| − | *[[Mesna (Mesnex)]] 720 mg/m<sup>2</sup> IV continuous infusion on day 1 | + | *[[Mesna (Mesnex)]] 720 mg/m<sup>2</sup> IV continuous infusion on day 1 |
**NOTE: Protocol states that [[Mesna (Mesnex)]] should be dosed as AT LEAST 60% of [[Cyclophosphamide (Cytoxan)]] m<sup>2</sup> | **NOTE: Protocol states that [[Mesna (Mesnex)]] should be dosed as AT LEAST 60% of [[Cyclophosphamide (Cytoxan)]] m<sup>2</sup> | ||
**[[Mesna (Mesnex)]] continuous infusion should be started at the same time as the [[Cyclophosphamide (Cytoxan)]] and remain until at least 8 hours after the end of the [[Cyclophosphamide (Cytoxan)]] infusion | **[[Mesna (Mesnex)]] continuous infusion should be started at the same time as the [[Cyclophosphamide (Cytoxan)]] and remain until at least 8 hours after the end of the [[Cyclophosphamide (Cytoxan)]] infusion | ||
| − | *[[Filgrastim (Neupogen)]] 5 mcg/kg SC for at least 7 days, or until ANC ≥ 750/μl, beginning on day 2 | + | *[[Filgrastim (Neupogen)]] 5 mcg/kg SC for at least 7 days, or until ANC ≥ 750/μl, beginning on day 2 |
**ANC ≥ 750/μl on or before day 7 of the cycle is not sufficient for discontinuing G-CSF | **ANC ≥ 750/μl on or before day 7 of the cycle is not sufficient for discontinuing G-CSF | ||
| − | |||
'''21 day cycle''' | '''21 day cycle''' | ||
| − | |||
===Regimen B Induction=== | ===Regimen B Induction=== | ||
*Regimen B is a consolidated regimen consisting of 14 day cycles | *Regimen B is a consolidated regimen consisting of 14 day cycles | ||
| Line 150: | Line 130: | ||
*[[Cyclophosphamide (Cytoxan)]] 1200 mg/m<sup>2</sup> IV over 1 hour on Days 1 | *[[Cyclophosphamide (Cytoxan)]] 1200 mg/m<sup>2</sup> IV over 1 hour on Days 1 | ||
**Treat with 50% doses calculated on a m<sup>2</sup> basis for children < 1 year, then consider increasing to 75% and then to 100 % of calculated dose if tolerated | **Treat with 50% doses calculated on a m<sup>2</sup> basis for children < 1 year, then consider increasing to 75% and then to 100 % of calculated dose if tolerated | ||
| − | *[[Mesna (Mesnex)]] 720 mg/m<sup>2</sup> IV continuous infusion on day 1 | + | *[[Mesna (Mesnex)]] 720 mg/m<sup>2</sup> IV continuous infusion on day 1 |
**NOTE: Protocol states that [[Mesna (Mesnex)]] should be dosed as AT LEAST 60% of [[Cyclophosphamide (Cytoxan)]] m<sup>2</sup> | **NOTE: Protocol states that [[Mesna (Mesnex)]] should be dosed as AT LEAST 60% of [[Cyclophosphamide (Cytoxan)]] m<sup>2</sup> | ||
**[[Mesna (Mesnex)]] continuous infusion should be started at the same time as the [[Cyclophosphamide (Cytoxan)]] and remain until at least 8 hours after the end of the [[Cyclophosphamide (Cytoxan)]] infusion | **[[Mesna (Mesnex)]] continuous infusion should be started at the same time as the [[Cyclophosphamide (Cytoxan)]] and remain until at least 8 hours after the end of the [[Cyclophosphamide (Cytoxan)]] infusion | ||
| − | *[[Filgrastim (Neupogen)]] 5 mcg/kg SC for at least 7 days, or until ANC ≥ 750/μl, beginning on day 2 | + | *[[Filgrastim (Neupogen)]] 5 mcg/kg SC for at least 7 days, or until ANC ≥ 750/μl, beginning on day 2 |
**ANC ≥ 750/μl on or before day 7 of the cycle is not sufficient for discontinuing G-CSF | **ANC ≥ 750/μl on or before day 7 of the cycle is not sufficient for discontinuing G-CSF | ||
| − | |||
'''14 day cycle''' | '''14 day cycle''' | ||
| − | |||
====Cycle 2, 4, & 6 (IE)==== | ====Cycle 2, 4, & 6 (IE)==== | ||
*[[Ifosfamide (Ifex)]] 1800 mg/m<sup>2</sup> IV infusion over 1 hour once on day 1 to 5 | *[[Ifosfamide (Ifex)]] 1800 mg/m<sup>2</sup> IV infusion over 1 hour once on day 1 to 5 | ||
| Line 163: | Line 141: | ||
*[[Etoposide (Vepesid)]] 100 mg/m<sup>2</sup> IV infusion over 1 to 2 hours once on days 1 to 5 | *[[Etoposide (Vepesid)]] 100 mg/m<sup>2</sup> IV infusion over 1 to 2 hours once on days 1 to 5 | ||
**Treat with 50% doses calculated on a m<sup>2</sup> basis for children < 1 year, then consider increasing to 75% and then to 100 % of calculated dose if tolerated | **Treat with 50% doses calculated on a m<sup>2</sup> basis for children < 1 year, then consider increasing to 75% and then to 100 % of calculated dose if tolerated | ||
| − | *[[Mesna (Mesnex)]] 1080 mg/m<sup>2</sup> IV continuous infusion on day 1 | + | *[[Mesna (Mesnex)]] 1080 mg/m<sup>2</sup> IV continuous infusion on day 1 |
**NOTE: Protocol states that [[Mesna (Mesnex)]] should be dosed as AT LEAST 60% of [[Ifosfamide (Ifex)]] m<sup>2</sup> | **NOTE: Protocol states that [[Mesna (Mesnex)]] should be dosed as AT LEAST 60% of [[Ifosfamide (Ifex)]] m<sup>2</sup> | ||
**[[Mesna (Mesnex)]] continuous infusion should be started at the same time as the [[Ifosfamide (Ifex)]] and remain until at least 8 hours after the end of the [[Ifosfamide (Ifex)]] infusion | **[[Mesna (Mesnex)]] continuous infusion should be started at the same time as the [[Ifosfamide (Ifex)]] and remain until at least 8 hours after the end of the [[Ifosfamide (Ifex)]] infusion | ||
*[[Filgrastim (Neupogen)]] 5 mcg/kg SC for at least 7 days, or until ANC ≥ 750/μl, beginning on day 6 | *[[Filgrastim (Neupogen)]] 5 mcg/kg SC for at least 7 days, or until ANC ≥ 750/μl, beginning on day 6 | ||
**ANC ≥ 750/μl on or before day 7 of the cycle is not sufficient for discontinuing G-CSF | **ANC ≥ 750/μl on or before day 7 of the cycle is not sufficient for discontinuing G-CSF | ||
| − | |||
'''14 day cycle''' | '''14 day cycle''' | ||
| − | |||
===Regimen B Continuation=== | ===Regimen B Continuation=== | ||
*At week 13 patients either underwent surgery, received radiation, or both | *At week 13 patients either underwent surgery, received radiation, or both | ||
| Line 176: | Line 152: | ||
====Cycle 7 (VDC)==== | ====Cycle 7 (VDC)==== | ||
Cycle 7 begins on week 15 in patients receiving surgery and on week 13 in Regimen B<sub>2</sub> | Cycle 7 begins on week 15 in patients receiving surgery and on week 13 in Regimen B<sub>2</sub> | ||
| − | |||
*[[Vincristine (Oncovin)]] 2 mg/m<sup>2</sup> IV push once on day 1 (maximum dose of 2 mg) | *[[Vincristine (Oncovin)]] 2 mg/m<sup>2</sup> IV push once on day 1 (maximum dose of 2 mg) | ||
**Treat with 50% doses calculated on a m<sup>2</sup> basis for children < 1 year, then consider increasing to 75% and then to 100 % of calculated dose if tolerated | **Treat with 50% doses calculated on a m<sup>2</sup> basis for children < 1 year, then consider increasing to 75% and then to 100 % of calculated dose if tolerated | ||
| Line 183: | Line 158: | ||
*[[Cyclophosphamide (Cytoxan)]] 1200 mg/m<sup>2</sup> IV over 1 hour on Days 1 | *[[Cyclophosphamide (Cytoxan)]] 1200 mg/m<sup>2</sup> IV over 1 hour on Days 1 | ||
**Treat with 50% doses calculated on a m<sup>2</sup> basis for children < 1 year, then consider increasing to 75% and then to 100 % of calculated dose if tolerated | **Treat with 50% doses calculated on a m<sup>2</sup> basis for children < 1 year, then consider increasing to 75% and then to 100 % of calculated dose if tolerated | ||
| − | *[[Mesna (Mesnex)]] 720 mg/m<sup>2</sup> IV continuous infusion on day 1 | + | *[[Mesna (Mesnex)]] 720 mg/m<sup>2</sup> IV continuous infusion on day 1 |
**NOTE: Protocol states that [[Mesna (Mesnex)]] should be dosed as AT LEAST 60% of [[Cyclophosphamide (Cytoxan)]] m<sup>2</sup> | **NOTE: Protocol states that [[Mesna (Mesnex)]] should be dosed as AT LEAST 60% of [[Cyclophosphamide (Cytoxan)]] m<sup>2</sup> | ||
**[[Mesna (Mesnex)]] continuous infusion should be started at the same time as the [[Cyclophosphamide (Cytoxan)]] and remain until at least 8 hours after the end of the [[Cyclophosphamide (Cytoxan)]] infusion | **[[Mesna (Mesnex)]] continuous infusion should be started at the same time as the [[Cyclophosphamide (Cytoxan)]] and remain until at least 8 hours after the end of the [[Cyclophosphamide (Cytoxan)]] infusion | ||
| − | *[[Filgrastim (Neupogen)]] 5 mcg/kg SC for at least 7 days, or until ANC ≥ 750/μl, beginning on day 2 | + | *[[Filgrastim (Neupogen)]] 5 mcg/kg SC for at least 7 days, or until ANC ≥ 750/μl, beginning on day 2 |
**ANC ≥ 750/μl on or before day 7 of the cycle is not sufficient for discontinuing G-CSF | **ANC ≥ 750/μl on or before day 7 of the cycle is not sufficient for discontinuing G-CSF | ||
| − | |||
'''14 day cycle''' | '''14 day cycle''' | ||
| Line 197: | Line 171: | ||
*[[Etoposide (Vepesid)]] 100 mg/m<sup>2</sup> IV infusion over 1 to 2 hours once on days 1 to 5 | *[[Etoposide (Vepesid)]] 100 mg/m<sup>2</sup> IV infusion over 1 to 2 hours once on days 1 to 5 | ||
**Treat with 50% doses calculated on a m<sup>2</sup> basis for children < 1 year, then consider increasing to 75% and then to 100 % of calculated dose if tolerated | **Treat with 50% doses calculated on a m<sup>2</sup> basis for children < 1 year, then consider increasing to 75% and then to 100 % of calculated dose if tolerated | ||
| − | *[[Mesna (Mesnex)]] 1080 mg/m<sup>2</sup> IV continuous infusion on day 1 | + | *[[Mesna (Mesnex)]] 1080 mg/m<sup>2</sup> IV continuous infusion on day 1 |
**NOTE: Protocol states that [[Mesna (Mesnex)]] should be dosed as AT LEAST 60% of [[Ifosfamide (Ifex)]] m<sup>2</sup> | **NOTE: Protocol states that [[Mesna (Mesnex)]] should be dosed as AT LEAST 60% of [[Ifosfamide (Ifex)]] m<sup>2</sup> | ||
**[[Mesna (Mesnex)]] continuous infusion should be started at the same time as the [[Ifosfamide (Ifex)]] and remain until at least 8 hours after the end of the [[Ifosfamide (Ifex)]] infusion | **[[Mesna (Mesnex)]] continuous infusion should be started at the same time as the [[Ifosfamide (Ifex)]] and remain until at least 8 hours after the end of the [[Ifosfamide (Ifex)]] infusion | ||
*[[Filgrastim (Neupogen)]] 5 mcg/kg SC for at least 7 days, or until ANC ≥ 750/μl, beginning on day 6 | *[[Filgrastim (Neupogen)]] 5 mcg/kg SC for at least 7 days, or until ANC ≥ 750/μl, beginning on day 6 | ||
**ANC ≥ 750/μl on or before day 7 of the cycle is not sufficient for discontinuing G-CSF | **ANC ≥ 750/μl on or before day 7 of the cycle is not sufficient for discontinuing G-CSF | ||
| − | |||
'''14 day cycle''' | '''14 day cycle''' | ||
| − | |||
====Cycle 9 (VDC) Regimen B<sub>1</sub> (Surgery Only)==== | ====Cycle 9 (VDC) Regimen B<sub>1</sub> (Surgery Only)==== | ||
*[[Vincristine (Oncovin)]] 2 mg/m<sup>2</sup> IV push once on day 1 (maximum dose of 2 mg) | *[[Vincristine (Oncovin)]] 2 mg/m<sup>2</sup> IV push once on day 1 (maximum dose of 2 mg) | ||
| Line 212: | Line 184: | ||
*[[Cyclophosphamide (Cytoxan)]] 1200 mg/m<sup>2</sup> IV over 1 hour on Days 1 | *[[Cyclophosphamide (Cytoxan)]] 1200 mg/m<sup>2</sup> IV over 1 hour on Days 1 | ||
**Treat with 50% doses calculated on a m<sup>2</sup> basis for children < 1 year, then consider increasing to 75% and then to 100 % of calculated dose if tolerated | **Treat with 50% doses calculated on a m<sup>2</sup> basis for children < 1 year, then consider increasing to 75% and then to 100 % of calculated dose if tolerated | ||
| − | *[[Mesna (Mesnex)]] 720 mg/m<sup>2</sup> IV continuous infusion on day 1 | + | *[[Mesna (Mesnex)]] 720 mg/m<sup>2</sup> IV continuous infusion on day 1 |
**NOTE: Protocol states that [[Mesna (Mesnex)]] should be dosed as AT LEAST 60% of [[Cyclophosphamide (Cytoxan)]] m<sup>2</sup> | **NOTE: Protocol states that [[Mesna (Mesnex)]] should be dosed as AT LEAST 60% of [[Cyclophosphamide (Cytoxan)]] m<sup>2</sup> | ||
**[[Mesna (Mesnex)]] continuous infusion should be started at the same time as the [[Cyclophosphamide (Cytoxan)]] and remain until at least 8 hours after the end of the [[Cyclophosphamide (Cytoxan)]] infusion | **[[Mesna (Mesnex)]] continuous infusion should be started at the same time as the [[Cyclophosphamide (Cytoxan)]] and remain until at least 8 hours after the end of the [[Cyclophosphamide (Cytoxan)]] infusion | ||
| − | *[[Filgrastim (Neupogen)]] 5 mcg/kg SC for at least 7 days, or until ANC ≥ 750/μl, beginning on day 2 | + | *[[Filgrastim (Neupogen)]] 5 mcg/kg SC for at least 7 days, or until ANC ≥ 750/μl, beginning on day 2 |
**ANC ≥ 750/μl on or before day 7 of the cycle is not sufficient for discontinuing G-CSF | **ANC ≥ 750/μl on or before day 7 of the cycle is not sufficient for discontinuing G-CSF | ||
| − | |||
'''14 day cycle''' | '''14 day cycle''' | ||
| − | |||
====Cycle 9 (VC) Regimen B<sub>2</sub> & B<sub>3</sub> (Radiation w/ or w/o Surgery)==== | ====Cycle 9 (VC) Regimen B<sub>2</sub> & B<sub>3</sub> (Radiation w/ or w/o Surgery)==== | ||
*[[Vincristine (Oncovin)]] 2 mg/m<sup>2</sup> IV push once on day 1 (maximum dose of 2 mg) | *[[Vincristine (Oncovin)]] 2 mg/m<sup>2</sup> IV push once on day 1 (maximum dose of 2 mg) | ||
| Line 225: | Line 195: | ||
*[[Cyclophosphamide (Cytoxan)]] 1200 mg/m<sup>2</sup> IV over 1 hour on Days 1 | *[[Cyclophosphamide (Cytoxan)]] 1200 mg/m<sup>2</sup> IV over 1 hour on Days 1 | ||
**Treat with 50% doses calculated on a m<sup>2</sup> basis for children < 1 year, then consider increasing to 75% and then to 100 % of calculated dose if tolerated | **Treat with 50% doses calculated on a m<sup>2</sup> basis for children < 1 year, then consider increasing to 75% and then to 100 % of calculated dose if tolerated | ||
| − | *[[Mesna (Mesnex)]] 720 mg/m<sup>2</sup> IV continuous infusion on day 1 | + | *[[Mesna (Mesnex)]] 720 mg/m<sup>2</sup> IV continuous infusion on day 1 |
**NOTE: Protocol states that [[Mesna (Mesnex)]] should be dosed as AT LEAST 60% of [[Cyclophosphamide (Cytoxan)]] m<sup>2</sup> | **NOTE: Protocol states that [[Mesna (Mesnex)]] should be dosed as AT LEAST 60% of [[Cyclophosphamide (Cytoxan)]] m<sup>2</sup> | ||
**[[Mesna (Mesnex)]] continuous infusion should be started at the same time as the [[Cyclophosphamide (Cytoxan)]] and remain until at least 8 hours after the end of the [[Cyclophosphamide (Cytoxan)]] infusion | **[[Mesna (Mesnex)]] continuous infusion should be started at the same time as the [[Cyclophosphamide (Cytoxan)]] and remain until at least 8 hours after the end of the [[Cyclophosphamide (Cytoxan)]] infusion | ||
| − | *[[Filgrastim (Neupogen)]] 5 mcg/kg SC for at least 7 days, or until ANC ≥ 750/μl, beginning on day 2 | + | *[[Filgrastim (Neupogen)]] 5 mcg/kg SC for at least 7 days, or until ANC ≥ 750/μl, beginning on day 2 |
**ANC ≥ 750/μl on or before day 7 of the cycle is not sufficient for discontinuing G-CSF | **ANC ≥ 750/μl on or before day 7 of the cycle is not sufficient for discontinuing G-CSF | ||
| − | |||
'''14 day cycle''' | '''14 day cycle''' | ||
| − | |||
====Cycle 11 (VC)==== | ====Cycle 11 (VC)==== | ||
*[[Vincristine (Oncovin)]] 2 mg/m<sup>2</sup> IV push once on day 1 (maximum dose of 2 mg) | *[[Vincristine (Oncovin)]] 2 mg/m<sup>2</sup> IV push once on day 1 (maximum dose of 2 mg) | ||
| Line 238: | Line 206: | ||
*[[Cyclophosphamide (Cytoxan)]] 1200 mg/m<sup>2</sup> IV over 1 hour on Days 1 | *[[Cyclophosphamide (Cytoxan)]] 1200 mg/m<sup>2</sup> IV over 1 hour on Days 1 | ||
**Treat with 50% doses calculated on a m<sup>2</sup> basis for children < 1 year, then consider increasing to 75% and then to 100 % of calculated dose if tolerated | **Treat with 50% doses calculated on a m<sup>2</sup> basis for children < 1 year, then consider increasing to 75% and then to 100 % of calculated dose if tolerated | ||
| − | *[[Mesna (Mesnex)]] 720 mg/m<sup>2</sup> IV continuous infusion on day 1 | + | *[[Mesna (Mesnex)]] 720 mg/m<sup>2</sup> IV continuous infusion on day 1 |
**NOTE: Protocol states that [[Mesna (Mesnex)]] should be dosed as AT LEAST 60% of [[Cyclophosphamide (Cytoxan)]] m<sup>2</sup> | **NOTE: Protocol states that [[Mesna (Mesnex)]] should be dosed as AT LEAST 60% of [[Cyclophosphamide (Cytoxan)]] m<sup>2</sup> | ||
**[[Mesna (Mesnex)]] continuous infusion should be started at the same time as the [[Cyclophosphamide (Cytoxan)]] and remain until at least 8 hours after the end of the [[Cyclophosphamide (Cytoxan)]] infusion | **[[Mesna (Mesnex)]] continuous infusion should be started at the same time as the [[Cyclophosphamide (Cytoxan)]] and remain until at least 8 hours after the end of the [[Cyclophosphamide (Cytoxan)]] infusion | ||
| − | *[[Filgrastim (Neupogen)]] 5 mcg/kg SC for at least 7 days, or until ANC ≥ 750/μl, beginning on day 2 | + | *[[Filgrastim (Neupogen)]] 5 mcg/kg SC for at least 7 days, or until ANC ≥ 750/μl, beginning on day 2 |
**ANC ≥ 750/μl on or before day 7 of the cycle is not sufficient for discontinuing G-CSF | **ANC ≥ 750/μl on or before day 7 of the cycle is not sufficient for discontinuing G-CSF | ||
| − | |||
'''14 day cycle''' | '''14 day cycle''' | ||
| − | |||
====Cycle 13 (VC) Regimen B<sub>1</sub> (Surgery Only)==== | ====Cycle 13 (VC) Regimen B<sub>1</sub> (Surgery Only)==== | ||
*[[Vincristine (Oncovin)]] 2 mg/m<sup>2</sup> IV push once on day 1 (maximum dose of 2 mg) | *[[Vincristine (Oncovin)]] 2 mg/m<sup>2</sup> IV push once on day 1 (maximum dose of 2 mg) | ||
| Line 251: | Line 217: | ||
*[[Cyclophosphamide (Cytoxan)]] 1200 mg/m<sup>2</sup> IV over 1 hour on Days 1 | *[[Cyclophosphamide (Cytoxan)]] 1200 mg/m<sup>2</sup> IV over 1 hour on Days 1 | ||
**Treat with 50% doses calculated on a m<sup>2</sup> basis for children < 1 year, then consider increasing to 75% and then to 100 % of calculated dose if tolerated | **Treat with 50% doses calculated on a m<sup>2</sup> basis for children < 1 year, then consider increasing to 75% and then to 100 % of calculated dose if tolerated | ||
| − | *[[Mesna (Mesnex)]] 720 mg/m<sup>2</sup> IV continuous infusion on day 1 | + | *[[Mesna (Mesnex)]] 720 mg/m<sup>2</sup> IV continuous infusion on day 1 |
**NOTE: Protocol states that [[Mesna (Mesnex)]] should be dosed as AT LEAST 60% of [[Cyclophosphamide (Cytoxan)]] m<sup>2</sup> | **NOTE: Protocol states that [[Mesna (Mesnex)]] should be dosed as AT LEAST 60% of [[Cyclophosphamide (Cytoxan)]] m<sup>2</sup> | ||
**[[Mesna (Mesnex)]] continuous infusion should be started at the same time as the [[Cyclophosphamide (Cytoxan)]] and remain until at least 8 hours after the end of the [[Cyclophosphamide (Cytoxan)]] infusion | **[[Mesna (Mesnex)]] continuous infusion should be started at the same time as the [[Cyclophosphamide (Cytoxan)]] and remain until at least 8 hours after the end of the [[Cyclophosphamide (Cytoxan)]] infusion | ||
| − | *[[Filgrastim (Neupogen)]] 5 mcg/kg SC for at least 7 days, or until ANC ≥ 750/μl, beginning on day 2 | + | *[[Filgrastim (Neupogen)]] 5 mcg/kg SC for at least 7 days, or until ANC ≥ 750/μl, beginning on day 2 |
**ANC ≥ 750/μl on or before day 7 of the cycle is not sufficient for discontinuing G-CSF | **ANC ≥ 750/μl on or before day 7 of the cycle is not sufficient for discontinuing G-CSF | ||
| − | |||
'''14 day cycle''' | '''14 day cycle''' | ||
| − | |||
====Cycle 13 (VDC) Regimen B<sub>2</sub> & B<sub>3</sub> (Radiation w/ or w/o Surgery)==== | ====Cycle 13 (VDC) Regimen B<sub>2</sub> & B<sub>3</sub> (Radiation w/ or w/o Surgery)==== | ||
*[[Vincristine (Oncovin)]] 2 mg/m<sup>2</sup> IV push once on day 1 (maximum dose of 2 mg) | *[[Vincristine (Oncovin)]] 2 mg/m<sup>2</sup> IV push once on day 1 (maximum dose of 2 mg) | ||
| Line 266: | Line 230: | ||
*[[Cyclophosphamide (Cytoxan)]] 1200 mg/m<sup>2</sup> IV over 1 hour on Days 1 | *[[Cyclophosphamide (Cytoxan)]] 1200 mg/m<sup>2</sup> IV over 1 hour on Days 1 | ||
**Treat with 50% doses calculated on a m<sup>2</sup> basis for children < 1 year, then consider increasing to 75% and then to 100 % of calculated dose if tolerated | **Treat with 50% doses calculated on a m<sup>2</sup> basis for children < 1 year, then consider increasing to 75% and then to 100 % of calculated dose if tolerated | ||
| − | *[[Mesna (Mesnex)]] 720 mg/m<sup>2</sup> IV continuous infusion on day 1 | + | *[[Mesna (Mesnex)]] 720 mg/m<sup>2</sup> IV continuous infusion on day 1 |
**NOTE: Protocol states that [[Mesna (Mesnex)]] should be dosed as AT LEAST 60% of [[Cyclophosphamide (Cytoxan)]] m<sup>2</sup> | **NOTE: Protocol states that [[Mesna (Mesnex)]] should be dosed as AT LEAST 60% of [[Cyclophosphamide (Cytoxan)]] m<sup>2</sup> | ||
**[[Mesna (Mesnex)]] continuous infusion should be started at the same time as the [[Cyclophosphamide (Cytoxan)]] and remain until at least 8 hours after the end of the [[Cyclophosphamide (Cytoxan)]] infusion | **[[Mesna (Mesnex)]] continuous infusion should be started at the same time as the [[Cyclophosphamide (Cytoxan)]] and remain until at least 8 hours after the end of the [[Cyclophosphamide (Cytoxan)]] infusion | ||
| − | *[[Filgrastim (Neupogen)]] 5 mcg/kg SC for at least 7 days, or until ANC ≥ 750/μl, beginning on day 2 | + | *[[Filgrastim (Neupogen)]] 5 mcg/kg SC for at least 7 days, or until ANC ≥ 750/μl, beginning on day 2 |
**ANC ≥ 750/μl on or before day 7 of the cycle is not sufficient for discontinuing G-CSF | **ANC ≥ 750/μl on or before day 7 of the cycle is not sufficient for discontinuing G-CSF | ||
| − | |||
'''14 day cycle''' | '''14 day cycle''' | ||
| − | |||
===References=== | ===References=== | ||
| − | #'''COG AEWS0031:''' Womer RB, West DC, Krailo MD, Dickman PS, Pawel BR, Grier HE, Marcus K, Sailer S, Healey JH, Dormans JP, and Weiss AR. | + | #'''COG AEWS0031:''' Womer RB, West DC, Krailo MD, Dickman PS, Pawel BR, Grier HE, Marcus K, Sailer S, Healey JH, Dormans JP, and Weiss AR. Randomized Controlled Trial of Interval-Compressed Chemotherapy for the Treatment of Localized Ewing Sarcoma: A Report From the Children's Oncology Group. J Clin Oncol. 2012 Nov 20;30(33):4148-4154. [https://dx.doi.org/10.1200%2FJCO.2011.41.5703 link to original article] [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3494838/ link to PMC article] [https://pubmed.ncbi.nlm.nih.gov/23091096/ PubMed] NCT00006734 |
| Line 283: | Line 245: | ||
===Regimen B Induction=== | ===Regimen B Induction=== | ||
===Regimen B Consolidation=== | ===Regimen B Consolidation=== | ||
| − | |||
| − | |||
[[Category:Disease-specific pages]] | [[Category:Disease-specific pages]] | ||
[[Category:Bone sarcomas]] | [[Category:Bone sarcomas]] | ||
[[Category:Pediatric solid tumors]] | [[Category:Pediatric solid tumors]] | ||
Revision as of 20:42, 14 April 2022
0 regimens on this page
0 variants on this page
|
Upfront Therapy
COG AEWS0031
Regimen A Induction
- Regimen A is a standard regimen consisting of 21 day cycles
Cycles 1 & 3 (VDC)
- Vincristine (Oncovin) 2 mg/m2 IV push once on day 1 (maximum dose of 2 mg)
- Treat with 50% doses calculated on a m2 basis for children < 1 year, then consider increasing to 75% and then to 100 % of calculated dose if tolerated
- Doxorubicin (Adriamycin) 75 mg/m2 IV infusion over 48 hours once on day 1
- Treat with 50% doses calculated on a m2 basis for children < 1 year, then consider increasing to 75% and then to 100 % of calculated dose if tolerated
- Cyclophosphamide (Cytoxan) 1200 mg/m2 IV over 1 hour on Days 1
- Treat with 50% doses calculated on a m2 basis for children < 1 year, then consider increasing to 75% and then to 100 % of calculated dose if tolerated
- Mesna (Mesnex) 720 mg/m2 IV continuous infusion on day 1
- NOTE: Protocol states that Mesna (Mesnex) should be dosed as AT LEAST 60% of Cyclophosphamide (Cytoxan) m2
- Mesna (Mesnex) continuous infusion should be started at the same time as the Cyclophosphamide (Cytoxan) and remain until at least 8 hours after the end of the Cyclophosphamide (Cytoxan) infusion
- Filgrastim (Neupogen) 5 mcg/kg SC for at least 7 days, or until ANC ≥ 750/μl, beginning on day 2
- ANC ≥ 750/μl on or before day 7 of the cycle is not sufficient for discontinuing G-CSF
21 day cycle
Cycles 2 & 4 (IE)
- Ifosfamide (Ifex) 1800 mg/m2 IV infusion over 1 hour once on day 1 to 5
- Treat with 50% doses calculated on a m2 basis for children < 1 year, then consider increasing to 75% and then to 100 % of calculated dose if tolerated
- Etoposide (Vepesid) 100 mg/m2 IV infusion over 1 to 2 hours once on days 1 to 5
- Treat with 50% doses calculated on a m2 basis for children < 1 year, then consider increasing to 75% and then to 100 % of calculated dose if tolerated
- Mesna (Mesnex) 1080 mg/m2 IV continuous infusion on day 1
- NOTE: Protocol states that Mesna (Mesnex) should be dosed as AT LEAST 60% of Ifosfamide (Ifex) m2
- Mesna (Mesnex) continuous infusion should be started at the same time as the Ifosfamide (Ifex) and remain until at least 8 hours after the end of the Ifosfamide (Ifex) infusion
- Filgrastim (Neupogen) 5 mcg/kg SC for at least 7 days, or until ANC ≥ 750/μl, beginning on day 6
- ANC ≥ 750/μl on or before day 7 of the cycle is not sufficient for discontinuing G-CSF
21 day cycle
Regimen A Continuation
- At week 13 patients either underwent surgery, received radiation, or both
- Radiation coincided with cycle 5
Cycle 5 & 9 (VDC)
Cycle 5 begins on week 15 in patients receiving surgery and on week 13 in Regimen A2
- Vincristine (Oncovin) 2 mg/m2 IV push once on day 1 (maximum dose of 2 mg)
- Treat with 50% doses calculated on a m2 basis for children < 1 year, then consider increasing to 75% and then to 100 % of calculated dose if tolerated
- Doxorubicin (Adriamycin) 75 mg/m2 IV infusion over 48 hours once on day 1
- Treat with 50% doses calculated on a m2 basis for children < 1 year, then consider increasing to 75% and then to 100 % of calculated dose if tolerated
- Cyclophosphamide (Cytoxan) 1200 mg/m2 IV over 1 hour on Days 1
- Treat with 50% doses calculated on a m2 basis for children < 1 year, then consider increasing to 75% and then to 100 % of calculated dose if tolerated
- Mesna (Mesnex) 720 mg/m2 IV continuous infusion on day 1
- NOTE: Protocol states that Mesna (Mesnex) should be dosed as AT LEAST 60% of Cyclophosphamide (Cytoxan) m2
- Mesna (Mesnex) continuous infusion should be started at the same time as the Cyclophosphamide (Cytoxan) and remain until at least 8 hours after the end of the Cyclophosphamide (Cytoxan) infusion
- Filgrastim (Neupogen) 5 mcg/kg SC for at least 7 days, or until ANC ≥ 750/μl, beginning on day 2
- ANC ≥ 750/μl on or before day 7 of the cycle is not sufficient for discontinuing G-CSF
21 day cycle
Cycle 6, 8, 10, 12, & 14 (IE)
- Ifosfamide (Ifex) 1800 mg/m2 IV infusion over 1 hour once on day 1 to 5
- Treat with 50% doses calculated on a m2 basis for children < 1 year, then consider increasing to 75% and then to 100 % of calculated dose if tolerated
- Etoposide (Vepesid) 100 mg/m2 IV infusion over 1 to 2 hours once on days 1 to 5
- Treat with 50% doses calculated on a m2 basis for children < 1 year, then consider increasing to 75% and then to 100 % of calculated dose if tolerated
- Mesna (Mesnex) 1080 mg/m2 IV continuous infusion on day 1
- NOTE: Protocol states that Mesna (Mesnex) should be dosed as AT LEAST 60% of Ifosfamide (Ifex) m2
- Mesna (Mesnex) continuous infusion should be started at the same time as the Ifosfamide (Ifex) and remain until at least 8 hours after the end of the Ifosfamide (Ifex) infusion
- Filgrastim (Neupogen) 5 mcg/kg SC for at least 7 days, or until ANC ≥ 750/μl, beginning on day 6
- ANC ≥ 750/μl on or before day 7 of the cycle is not sufficient for discontinuing G-CSF
21 day cycle
Cycle 7 (VDC) Regimen A1 (Surgery Only)
- Vincristine (Oncovin) 2 mg/m2 IV push once on day 1 (maximum dose of 2 mg)
- Treat with 50% doses calculated on a m2 basis for children < 1 year, then consider increasing to 75% and then to 100 % of calculated dose if tolerated
- Doxorubicin (Adriamycin) 75 mg/m2 IV infusion over 48 hours once on day 1
- Treat with 50% doses calculated on a m2 basis for children < 1 year, then consider increasing to 75% and then to 100 % of calculated dose if tolerated
- Cyclophosphamide (Cytoxan) 1200 mg/m2 IV over 1 hour on Days 1
- Treat with 50% doses calculated on a m2 basis for children < 1 year, then consider increasing to 75% and then to 100 % of calculated dose if tolerated
- Mesna (Mesnex) 720 mg/m2 IV continuous infusion on day 1
- NOTE: Protocol states that Mesna (Mesnex) should be dosed as AT LEAST 60% of Cyclophosphamide (Cytoxan) m2
- Mesna (Mesnex) continuous infusion should be started at the same time as the Cyclophosphamide (Cytoxan) and remain until at least 8 hours after the end of the Cyclophosphamide (Cytoxan) infusion
- Filgrastim (Neupogen) 5 mcg/kg SC for at least 7 days, or until ANC ≥ 750/μl, beginning on day 2
- ANC ≥ 750/μl on or before day 7 of the cycle is not sufficient for discontinuing G-CSF
21 day cycle
Cycle 7 (VC) Regimen A2 & A3 (Radiation w/ or w/o Surgery)
- Vincristine (Oncovin) 2 mg/m2 IV push once on day 1 (maximum dose of 2 mg)
- Treat with 50% doses calculated on a m2 basis for children < 1 year, then consider increasing to 75% and then to 100 % of calculated dose if tolerated
- Cyclophosphamide (Cytoxan) 1200 mg/m2 IV over 1 hour on Days 1
- Treat with 50% doses calculated on a m2 basis for children < 1 year, then consider increasing to 75% and then to 100 % of calculated dose if tolerated
- Mesna (Mesnex) 720 mg/m2 IV continuous infusion on day 1
- NOTE: Protocol states that Mesna (Mesnex) should be dosed as AT LEAST 60% of Cyclophosphamide (Cytoxan) m2
- Mesna (Mesnex) continuous infusion should be started at the same time as the Cyclophosphamide (Cytoxan) and remain until at least 8 hours after the end of the Cyclophosphamide (Cytoxan) infusion
- Filgrastim (Neupogen) 5 mcg/kg SC for at least 7 days, or until ANC ≥ 750/μl, beginning on day 2
- ANC ≥ 750/μl on or before day 7 of the cycle is not sufficient for discontinuing G-CSF
21 day cycle
Cycle 11 (VC) Regimen A1 (Surgery Only)
- Vincristine (Oncovin) 2 mg/m2 IV push once on day 1 (maximum dose of 2 mg)
- Treat with 50% doses calculated on a m2 basis for children < 1 year, then consider increasing to 75% and then to 100 % of calculated dose if tolerated
- Cyclophosphamide (Cytoxan) 1200 mg/m2 IV over 1 hour on Days 1
- Treat with 50% doses calculated on a m2 basis for children < 1 year, then consider increasing to 75% and then to 100 % of calculated dose if tolerated
- Mesna (Mesnex) 720 mg/m2 IV continuous infusion on day 1
- NOTE: Protocol states that Mesna (Mesnex) should be dosed as AT LEAST 60% of Cyclophosphamide (Cytoxan) m2
- Mesna (Mesnex) continuous infusion should be started at the same time as the Cyclophosphamide (Cytoxan) and remain until at least 8 hours after the end of the Cyclophosphamide (Cytoxan) infusion
- Filgrastim (Neupogen) 5 mcg/kg SC for at least 7 days, or until ANC ≥ 750/μl, beginning on day 2
- ANC ≥ 750/μl on or before day 7 of the cycle is not sufficient for discontinuing G-CSF
21 day cycle
Cycle 11 (VDC) Regimen A2 & A3 (Radiation w/ or w/o Surgery)
- Vincristine (Oncovin) 2 mg/m2 IV push once on day 1 (maximum dose of 2 mg)
- Treat with 50% doses calculated on a m2 basis for children < 1 year, then consider increasing to 75% and then to 100 % of calculated dose if tolerated
- Doxorubicin (Adriamycin) 75 mg/m2 IV infusion over 48 hours once on day 1
- Treat with 50% doses calculated on a m2 basis for children < 1 year, then consider increasing to 75% and then to 100 % of calculated dose if tolerated
- Cyclophosphamide (Cytoxan) 1200 mg/m2 IV over 1 hour on Days 1
- Treat with 50% doses calculated on a m2 basis for children < 1 year, then consider increasing to 75% and then to 100 % of calculated dose if tolerated
- Mesna (Mesnex) 720 mg/m2 IV continuous infusion on day 1
- NOTE: Protocol states that Mesna (Mesnex) should be dosed as AT LEAST 60% of Cyclophosphamide (Cytoxan) m2
- Mesna (Mesnex) continuous infusion should be started at the same time as the Cyclophosphamide (Cytoxan) and remain until at least 8 hours after the end of the Cyclophosphamide (Cytoxan) infusion
- Filgrastim (Neupogen) 5 mcg/kg SC for at least 7 days, or until ANC ≥ 750/μl, beginning on day 2
- ANC ≥ 750/μl on or before day 7 of the cycle is not sufficient for discontinuing G-CSF
21 day cycle
Cycle 13 (VC)
- Vincristine (Oncovin) 2 mg/m2 IV push once on day 1 (maximum dose of 2 mg)
- Treat with 50% doses calculated on a m2 basis for children < 1 year, then consider increasing to 75% and then to 100 % of calculated dose if tolerated
- Cyclophosphamide (Cytoxan) 1200 mg/m2 IV over 1 hour on Days 1
- Treat with 50% doses calculated on a m2 basis for children < 1 year, then consider increasing to 75% and then to 100 % of calculated dose if tolerated
- Mesna (Mesnex) 720 mg/m2 IV continuous infusion on day 1
- NOTE: Protocol states that Mesna (Mesnex) should be dosed as AT LEAST 60% of Cyclophosphamide (Cytoxan) m2
- Mesna (Mesnex) continuous infusion should be started at the same time as the Cyclophosphamide (Cytoxan) and remain until at least 8 hours after the end of the Cyclophosphamide (Cytoxan) infusion
- Filgrastim (Neupogen) 5 mcg/kg SC for at least 7 days, or until ANC ≥ 750/μl, beginning on day 2
- ANC ≥ 750/μl on or before day 7 of the cycle is not sufficient for discontinuing G-CSF
21 day cycle
Regimen B Induction
- Regimen B is a consolidated regimen consisting of 14 day cycles
Cycles 1, 3, & 5 (VDC)
- Vincristine (Oncovin) 2 mg/m2 IV push once on day 1 (maximum dose of 2 mg)
- Treat with 50% doses calculated on a m2 basis for children < 1 year, then consider increasing to 75% and then to 100 % of calculated dose if tolerated
- Doxorubicin (Adriamycin) 75 mg/m2 IV infusion over 48 hours once on day 1
- Treat with 50% doses calculated on a m2 basis for children < 1 year, then consider increasing to 75% and then to 100 % of calculated dose if tolerated
- Cyclophosphamide (Cytoxan) 1200 mg/m2 IV over 1 hour on Days 1
- Treat with 50% doses calculated on a m2 basis for children < 1 year, then consider increasing to 75% and then to 100 % of calculated dose if tolerated
- Mesna (Mesnex) 720 mg/m2 IV continuous infusion on day 1
- NOTE: Protocol states that Mesna (Mesnex) should be dosed as AT LEAST 60% of Cyclophosphamide (Cytoxan) m2
- Mesna (Mesnex) continuous infusion should be started at the same time as the Cyclophosphamide (Cytoxan) and remain until at least 8 hours after the end of the Cyclophosphamide (Cytoxan) infusion
- Filgrastim (Neupogen) 5 mcg/kg SC for at least 7 days, or until ANC ≥ 750/μl, beginning on day 2
- ANC ≥ 750/μl on or before day 7 of the cycle is not sufficient for discontinuing G-CSF
14 day cycle
Cycle 2, 4, & 6 (IE)
- Ifosfamide (Ifex) 1800 mg/m2 IV infusion over 1 hour once on day 1 to 5
- Treat with 50% doses calculated on a m2 basis for children < 1 year, then consider increasing to 75% and then to 100 % of calculated dose if tolerated
- Etoposide (Vepesid) 100 mg/m2 IV infusion over 1 to 2 hours once on days 1 to 5
- Treat with 50% doses calculated on a m2 basis for children < 1 year, then consider increasing to 75% and then to 100 % of calculated dose if tolerated
- Mesna (Mesnex) 1080 mg/m2 IV continuous infusion on day 1
- NOTE: Protocol states that Mesna (Mesnex) should be dosed as AT LEAST 60% of Ifosfamide (Ifex) m2
- Mesna (Mesnex) continuous infusion should be started at the same time as the Ifosfamide (Ifex) and remain until at least 8 hours after the end of the Ifosfamide (Ifex) infusion
- Filgrastim (Neupogen) 5 mcg/kg SC for at least 7 days, or until ANC ≥ 750/μl, beginning on day 6
- ANC ≥ 750/μl on or before day 7 of the cycle is not sufficient for discontinuing G-CSF
14 day cycle
Regimen B Continuation
- At week 13 patients either underwent surgery, received radiation, or both
- Radiation coincided with cycle 7
Cycle 7 (VDC)
Cycle 7 begins on week 15 in patients receiving surgery and on week 13 in Regimen B2
- Vincristine (Oncovin) 2 mg/m2 IV push once on day 1 (maximum dose of 2 mg)
- Treat with 50% doses calculated on a m2 basis for children < 1 year, then consider increasing to 75% and then to 100 % of calculated dose if tolerated
- Doxorubicin (Adriamycin) 75 mg/m2 IV infusion over 48 hours once on day 1
- Treat with 50% doses calculated on a m2 basis for children < 1 year, then consider increasing to 75% and then to 100 % of calculated dose if tolerated
- Cyclophosphamide (Cytoxan) 1200 mg/m2 IV over 1 hour on Days 1
- Treat with 50% doses calculated on a m2 basis for children < 1 year, then consider increasing to 75% and then to 100 % of calculated dose if tolerated
- Mesna (Mesnex) 720 mg/m2 IV continuous infusion on day 1
- NOTE: Protocol states that Mesna (Mesnex) should be dosed as AT LEAST 60% of Cyclophosphamide (Cytoxan) m2
- Mesna (Mesnex) continuous infusion should be started at the same time as the Cyclophosphamide (Cytoxan) and remain until at least 8 hours after the end of the Cyclophosphamide (Cytoxan) infusion
- Filgrastim (Neupogen) 5 mcg/kg SC for at least 7 days, or until ANC ≥ 750/μl, beginning on day 2
- ANC ≥ 750/μl on or before day 7 of the cycle is not sufficient for discontinuing G-CSF
14 day cycle
Cycle 8, 10, 12, & 14 (IE)
- Ifosfamide (Ifex) 1800 mg/m2 IV infusion over 1 hour once on day 1 to 5
- Treat with 50% doses calculated on a m2 basis for children < 1 year, then consider increasing to 75% and then to 100 % of calculated dose if tolerated
- Etoposide (Vepesid) 100 mg/m2 IV infusion over 1 to 2 hours once on days 1 to 5
- Treat with 50% doses calculated on a m2 basis for children < 1 year, then consider increasing to 75% and then to 100 % of calculated dose if tolerated
- Mesna (Mesnex) 1080 mg/m2 IV continuous infusion on day 1
- NOTE: Protocol states that Mesna (Mesnex) should be dosed as AT LEAST 60% of Ifosfamide (Ifex) m2
- Mesna (Mesnex) continuous infusion should be started at the same time as the Ifosfamide (Ifex) and remain until at least 8 hours after the end of the Ifosfamide (Ifex) infusion
- Filgrastim (Neupogen) 5 mcg/kg SC for at least 7 days, or until ANC ≥ 750/μl, beginning on day 6
- ANC ≥ 750/μl on or before day 7 of the cycle is not sufficient for discontinuing G-CSF
14 day cycle
Cycle 9 (VDC) Regimen B1 (Surgery Only)
- Vincristine (Oncovin) 2 mg/m2 IV push once on day 1 (maximum dose of 2 mg)
- Treat with 50% doses calculated on a m2 basis for children < 1 year, then consider increasing to 75% and then to 100 % of calculated dose if tolerated
- Doxorubicin (Adriamycin) 75 mg/m2 IV infusion over 48 hours once on day 1
- Treat with 50% doses calculated on a m2 basis for children < 1 year, then consider increasing to 75% and then to 100 % of calculated dose if tolerated
- Cyclophosphamide (Cytoxan) 1200 mg/m2 IV over 1 hour on Days 1
- Treat with 50% doses calculated on a m2 basis for children < 1 year, then consider increasing to 75% and then to 100 % of calculated dose if tolerated
- Mesna (Mesnex) 720 mg/m2 IV continuous infusion on day 1
- NOTE: Protocol states that Mesna (Mesnex) should be dosed as AT LEAST 60% of Cyclophosphamide (Cytoxan) m2
- Mesna (Mesnex) continuous infusion should be started at the same time as the Cyclophosphamide (Cytoxan) and remain until at least 8 hours after the end of the Cyclophosphamide (Cytoxan) infusion
- Filgrastim (Neupogen) 5 mcg/kg SC for at least 7 days, or until ANC ≥ 750/μl, beginning on day 2
- ANC ≥ 750/μl on or before day 7 of the cycle is not sufficient for discontinuing G-CSF
14 day cycle
Cycle 9 (VC) Regimen B2 & B3 (Radiation w/ or w/o Surgery)
- Vincristine (Oncovin) 2 mg/m2 IV push once on day 1 (maximum dose of 2 mg)
- Treat with 50% doses calculated on a m2 basis for children < 1 year, then consider increasing to 75% and then to 100 % of calculated dose if tolerated
- Cyclophosphamide (Cytoxan) 1200 mg/m2 IV over 1 hour on Days 1
- Treat with 50% doses calculated on a m2 basis for children < 1 year, then consider increasing to 75% and then to 100 % of calculated dose if tolerated
- Mesna (Mesnex) 720 mg/m2 IV continuous infusion on day 1
- NOTE: Protocol states that Mesna (Mesnex) should be dosed as AT LEAST 60% of Cyclophosphamide (Cytoxan) m2
- Mesna (Mesnex) continuous infusion should be started at the same time as the Cyclophosphamide (Cytoxan) and remain until at least 8 hours after the end of the Cyclophosphamide (Cytoxan) infusion
- Filgrastim (Neupogen) 5 mcg/kg SC for at least 7 days, or until ANC ≥ 750/μl, beginning on day 2
- ANC ≥ 750/μl on or before day 7 of the cycle is not sufficient for discontinuing G-CSF
14 day cycle
Cycle 11 (VC)
- Vincristine (Oncovin) 2 mg/m2 IV push once on day 1 (maximum dose of 2 mg)
- Treat with 50% doses calculated on a m2 basis for children < 1 year, then consider increasing to 75% and then to 100 % of calculated dose if tolerated
- Cyclophosphamide (Cytoxan) 1200 mg/m2 IV over 1 hour on Days 1
- Treat with 50% doses calculated on a m2 basis for children < 1 year, then consider increasing to 75% and then to 100 % of calculated dose if tolerated
- Mesna (Mesnex) 720 mg/m2 IV continuous infusion on day 1
- NOTE: Protocol states that Mesna (Mesnex) should be dosed as AT LEAST 60% of Cyclophosphamide (Cytoxan) m2
- Mesna (Mesnex) continuous infusion should be started at the same time as the Cyclophosphamide (Cytoxan) and remain until at least 8 hours after the end of the Cyclophosphamide (Cytoxan) infusion
- Filgrastim (Neupogen) 5 mcg/kg SC for at least 7 days, or until ANC ≥ 750/μl, beginning on day 2
- ANC ≥ 750/μl on or before day 7 of the cycle is not sufficient for discontinuing G-CSF
14 day cycle
Cycle 13 (VC) Regimen B1 (Surgery Only)
- Vincristine (Oncovin) 2 mg/m2 IV push once on day 1 (maximum dose of 2 mg)
- Treat with 50% doses calculated on a m2 basis for children < 1 year, then consider increasing to 75% and then to 100 % of calculated dose if tolerated
- Cyclophosphamide (Cytoxan) 1200 mg/m2 IV over 1 hour on Days 1
- Treat with 50% doses calculated on a m2 basis for children < 1 year, then consider increasing to 75% and then to 100 % of calculated dose if tolerated
- Mesna (Mesnex) 720 mg/m2 IV continuous infusion on day 1
- NOTE: Protocol states that Mesna (Mesnex) should be dosed as AT LEAST 60% of Cyclophosphamide (Cytoxan) m2
- Mesna (Mesnex) continuous infusion should be started at the same time as the Cyclophosphamide (Cytoxan) and remain until at least 8 hours after the end of the Cyclophosphamide (Cytoxan) infusion
- Filgrastim (Neupogen) 5 mcg/kg SC for at least 7 days, or until ANC ≥ 750/μl, beginning on day 2
- ANC ≥ 750/μl on or before day 7 of the cycle is not sufficient for discontinuing G-CSF
14 day cycle
Cycle 13 (VDC) Regimen B2 & B3 (Radiation w/ or w/o Surgery)
- Vincristine (Oncovin) 2 mg/m2 IV push once on day 1 (maximum dose of 2 mg)
- Treat with 50% doses calculated on a m2 basis for children < 1 year, then consider increasing to 75% and then to 100 % of calculated dose if tolerated
- Doxorubicin (Adriamycin) 75 mg/m2 IV infusion over 48 hours once on day 1
- Treat with 50% doses calculated on a m2 basis for children < 1 year, then consider increasing to 75% and then to 100 % of calculated dose if tolerated
- Cyclophosphamide (Cytoxan) 1200 mg/m2 IV over 1 hour on Days 1
- Treat with 50% doses calculated on a m2 basis for children < 1 year, then consider increasing to 75% and then to 100 % of calculated dose if tolerated
- Mesna (Mesnex) 720 mg/m2 IV continuous infusion on day 1
- NOTE: Protocol states that Mesna (Mesnex) should be dosed as AT LEAST 60% of Cyclophosphamide (Cytoxan) m2
- Mesna (Mesnex) continuous infusion should be started at the same time as the Cyclophosphamide (Cytoxan) and remain until at least 8 hours after the end of the Cyclophosphamide (Cytoxan) infusion
- Filgrastim (Neupogen) 5 mcg/kg SC for at least 7 days, or until ANC ≥ 750/μl, beginning on day 2
- ANC ≥ 750/μl on or before day 7 of the cycle is not sufficient for discontinuing G-CSF
14 day cycle
References
- COG AEWS0031: Womer RB, West DC, Krailo MD, Dickman PS, Pawel BR, Grier HE, Marcus K, Sailer S, Healey JH, Dormans JP, and Weiss AR. Randomized Controlled Trial of Interval-Compressed Chemotherapy for the Treatment of Localized Ewing Sarcoma: A Report From the Children's Oncology Group. J Clin Oncol. 2012 Nov 20;30(33):4148-4154. link to original article link to PMC article PubMed NCT00006734