Rhabdomyosarcoma, pediatric

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Upfront Therapy

COG ARST0431

Vincristine and Irinotecan

Weeks 1, 4, 20, 23, 47, & 50

• Vincristine (Oncovin) by the following age-based criteria:
  • Age ≥ 3 years: 1.5 mg/m² (maximum dose of 2 mg) IV push over 1 minute once on day 1
  • Age ≥ 1 year to < 3 years: 0.05 mg/kg (maximum dose of 2 mg) IV push over 1 minute once on day 1
  • Age < 1 year: 0.025 mg/kg IV push over 1 minute once on day 1

Administer Vincristine (Oncovin) before Irinotecan (Camptosar)

• Irinotecan (Camptosar) 50 mg/m² (maximum dose of 100 mg/day) IV over 60 minutes once per day on days 1 through 5

Vincristine Monotherapy

Weeks 2, 3, 5, 8, 12, 16, 21, 22, 24, 29, 33, 42, 43, 48, & 50 

• Vincristine (Oncovin) by the following age-based criteria:
  • Age ≥ 3 years: 1.5 mg/m² (maximum dose of 2 mg) IV push over 1 minute once on day 1
  • Age ≥ 1 year to < 3 years: 0.05 mg/kg (maximum dose of 2 mg) IV push over 1 minute once on day 1
  • Age < 1 year: 0.025 mg/kg IV push over 1 minute once on day 1

Off Chemotherapy Weeks

Weeks 6, 10, 14, 18, 19, 25, 27, 31, 34, 36, 37, 39, 40, 45, 46, 49, 52, 53, & 54

Vincristine, Doxorubicin, and Cyclophosphamide

Weeks 7, 11, 15, 28, & 32

• Vincristine (Oncovin) by the following age-based criteria:
  • Age ≥ 3 years: 1.5 mg/m² (maximum dose of 2 mg) IV push over 1 minute once on day 1
  • Age ≥ 1 year to < 3 years: 0.05 mg/kg (maximum dose of 2 mg) IV push over 1 minute once on day 1
  • Age < 1 year: 0.025 mg/kg IV push over 1 minute once on day 1
• Doxorubicin (Adriamycin) by the following age-based criteria:
  • Age ≥ 1 year: 37.5 mg/m² (Total dose per week of 75 mg/m²) IV over 24 hours once per day on days 1 through 2
  • Age < 1 year: 18.75 mg/m² IV over 24 hours once per day on days 1 through 2
• Cyclophosphamide (Cytoxan) by the following age-based criteria:
  • Age ≥ 3 years: 1200 mg/m² IV over 1 hour once per day on day 1
  • Age < 3 years: 40mg/kg IV over 1 hour once per day on day 1
• Mesna (Mesnex) by the following age-based criteria:
  • Age ≥ 3 years: 240 mg/m² at hour 0, 4, and 8 from the start of each Cyclophosphamide (Cytoxan) infusion on days 1
  • Age < 3 years: 8 mg/kg at hour 0, 4, and 8 from the start of each Cyclophosphamide (Cytoxan) infusion on days 1

Ifosfamide and Etoposide

Weeks 9, 13, 17, 26, & 30

• Ifosfamide (Ifex) by the following age-based criteria:
  • Age ≥ 1 year: 1800 mg/m² IV over 1 hour once per day on days 1 through 5
  • Age < 1 year: 900 mg/m² IV over 1 hour once per day on days 1 through 5
• Mesna (Mesnex) by the following age-based criteria:
  • Age ≥ 3 years: 360 mg/m² at hour 0, 4, and 8 from the start of each Ifosfamide (Ifex) infusion on days 1 through 5
  • Age < 3 years: 180 mg/m² at hour 0, 4, and 8 from the start of each Ifosfamide (Ifex) infusion on days 1 through 5
• Etoposide (Vepesid) by the following age-based criteria:
  • Age ≥ 1 year: 100 mg/m² IV over 30 to 60 minutes once per day on days 1 through 5
  • Age < 1 year: 50 mg/m² IV over 30 to 60 minutes once per day on days 1 through 5

Vincristine, Dactinomycin, and Cyclophosphamide

Weeks 35, 38, 41, & 44

• Vincristine (Oncovin) by the following age-based criteria:
  • Age ≥ 3 years: 1.5 mg/m² (maximum dose of 2 mg) IV push over 1 minute once on day 1
  • Age ≥ 1 year to < 3 years: 0.05 mg/kg (maximum dose of 2 mg) IV push over 1 minute once on day 1
  • Age < 1 year: 0.025 mg/kg IV push over 1 minute once on day 1
• Dactinomycin (Cosmegen) by the following age-based criteria:
  • Age ≥ 1 year: 0.045 mg/kg (maximum dose of 2.5 mg) IV push over 1 to 5 minutes once per day on day 1
  • Age < 1 year: 0.025 mg/kg IV over 1 to 5 minutes once per day on day 1
• Cyclophosphamide (Cytoxan) by the following age-based criteria:
  • Age ≥ 3 years: 1200 mg/m² IV over 1 hour once per day on day 1
  • Age < 3 years: 40mg/kg IV over 1 hour once per day on day 1
• Mesna (Mesnex) by the following age-based criteria:
  • Age ≥ 3 years: 240 mg/m² at hour 0, 4, and 8 from the start of each Cyclophosphamide (Cytoxan) infusion on days 1
  • Age < 3 years: 8 mg/kg at hour 0, 4, and 8 from the start of each Cyclophosphamide (Cytoxan) infusion on days 1

References

1. COG ARST0431: Weigel BJ, Lyden E, Anderson JR, Meyer WH, Parham DM, Rodeberg DA, Michalski JM, Hawkins DS, Arndt CAS. Intensive Multiagent Therapy, Including Dose-Compressed Cycles of Ifosfamide/Etoposide and Vincristine/Doxorubicin/Cyclophosphamide, Irinotecan, and Radiation, in Patients with High-Risk Rhabdomyosarcoma: A Report from the Children's Oncology Group. Journal of Clinical Oncology. 2016 Oct;34(2):117-122. link to original article link to PMC article PubMed NCT00354744