Difference between revisions of "Ewing sarcoma, pediatric"
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| + | =Upfront Therapy= | ||
| + | ==COGAEWS0031 Protocol== | ||
| + | ===Regimen A Induction=== | ||
| + | ====Cycles 1 & 3 (VDC)==== | ||
| + | *[[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 | ||
| + | *[[Doxorubicin (Adriamycin)]] 75 mg/m<sup>2</sup> IV infusion over 48 hours once on day 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 | ||
| + | *[[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 | ||
| + | *[[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> | ||
| + | **[[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/m<sup>2</sup> IV infusion over 1 hour once on day 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 | ||
| + | *[[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 | ||
| + | *[[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> | ||
| + | **[[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=== | ||
| + | ====Cycle 5 & 9 (VDC)==== | ||
| + | Cycle 5 begins on week 15 in patients receiving surgery week 13 (Regimen A1<sub>2</sub>/A3<sub>2</sub>) | ||
| + | |||
| + | |||
| + | |||
| + | ===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. [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 | ||
Revision as of 13:44, 26 March 2022
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Upfront Therapy
COGAEWS0031 Protocol
Regimen A Induction
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
Cycle 5 & 9 (VDC)
Cycle 5 begins on week 15 in patients receiving surgery week 13 (Regimen A12/A32)
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