Rhabdomyosarcoma, pediatric

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Upfront Therapy

COG ARST1431 (In Process)

Regimen A (VAC/VI Only)

Cycles 1-4 (Weeks 1 through 12)

Chemotherapy

• Vincristine (Oncovin) by the following BSA-based criteria:
  • 0.25-0.29 m² BSA: 0.24 mg IV push over 1 minute (or infusion via minibag as per institutional policy once weekly on day 1 of weeks 1 through 12
  • 0.3-0.34 m² BSA: 0.34 mg IV push over 1 minute (or infusion via minibag as per institutional policy once weekly on day 1 of weeks 1 through 12
  • 0.35-0.39 m² BSA: 0.44 mg IV push over 1 minute (or infusion via minibag as per institutional policy once weekly on day 1 of weeks 1 through 12
  • 0.4-0.44 m² BSA: 0.55 mg IV push over 1 minute (or infusion via minibag as per institutional policy once weekly on day 1 of weeks 1 through 12
  • 0.45-0.49 m² BSA: 0.65 mg IV push over 1 minute (or infusion via minibag as per institutional policy once weekly on day 1 of weeks 1 through 12
  • 0.5-0.54 m² BSA: 0.74 mg IV push over 1 minute (or infusion via minibag as per institutional policy once weekly on day 1 of weeks 1 through 12
  • 0.55-0.59 m² BSA: 0.8 mg IV push over 1 minute (or infusion via minibag as per institutional policy once weekly on day 1 of weeks 1 through 12
  • ≥ 0.6 m² BSA: 1.5 mg/m² (maximum dose of 2 mg) IV push over 1 minute (or infusion via minibag as per institutional policy once weekly on day 1 of weeks 1 through 12

• Dactinomycin (Cosmegen) by the following weight-based criteria:
  • 3-4.5 kg: 0.09 mg slow IV push over 1 to 5 minutes or IV infusion over 10 to 15 minutes on day 1 of weeks 1 and 7
  • 4.6-6 kg: 0.14 mg slow IV push over 1 to 5 minutes or IV infusion over 10 to 15 minutes on day 1 of weeks 1 and 7
  • 6.1-7.3 kg: 0.21 mg slow IV push over 1 to 5 minutes or IV infusion over 10 to 15 minutes on day 1 of weeks 1 and 7
  • 7.4-8.6 kg: 0.26 mg slow IV push over 1 to 5 minutes or IV infusion over 10 to 15 minutes on day 1 of weeks 1 and 7
  • 8.7-9.9 kg: 0.33 mg slow IV push over 1 to 5 minutes or IV infusion over 10 to 15 minutes on day 1 of weeks 1 and 7
  • 10-11.2 kg: 0.4 mg slow IV push over 1 to 5 minutes or IV infusion over 10 to 15 minutes on day 1 of weeks 1 and 7
  • 11.3-12.5 kg: 0.5 mg slow IV push over 1 to 5 minutes or IV infusion over 10 to 15 minutes on day 1 of weeks 1 and 7
  • 12.6-13.9 kg: 0.6 mg slow IV push over 1 to 5 minutes or IV infusion over 10 to 15 minutes on day 1 of weeks 1 and 7
  • ≥14 kg: 0.05 mg/kg (maximum dose of 2.5 mg) slow IV push over 1 to 5 minutes or IV infusion over 10 to 15 minutes on day 1 of weeks 1 and 7

• Cyclophosphamide (Cytoxan) by the following BSA-based criteria:
  • 0.25-0.29 m² BSA: 220 mg IV over 60 minutes on day 1 of weeks 1 and 7
  • 0.3-0.34 m² BSA: 280 mg IV over 60 minutes on day 1 of weeks 1 and 7
  • 0.35-0.39 m² BSA: 360 mg IV over 60 minutes on day 1 of weeks 1 and 7
  • 0.4-0.44 m² BSA: 440 mg IV over 60 minutes on day 1 of weeks 1 and 7
  • 0.45-0.49 m² BSA: 520 mg IV over 60 minutes on day 1 of weeks 1 and 7
  • 0.5-0.54 m² BSA: 600 mg IV over 60 minutes on day 1 of weeks 1 and 7
  • 0.55-0.59 m² BSA: 660 mg IV over 60 minutes on day 1 of weeks 1 and 7
  • ≥ 0.6 m² BSA: 1200 mg/m² IV over 60 minutes on day 1 of weeks 1 and 7

• Mesna (Mesnex) by the following BSA-based criteria:

Mesna (Mesnex) can also be given PO at twice the IV dose

• • 0.25-0.29 m² BSA: 176 mg IV over 15 to 30 minutes immediately before Cyclophosphamide (Cytoxan) infusion, and again 4 and 8 hours after the start of Cyclophosphamide (Cytoxan) infusion
  • 0.3-0.34 m² BSA: 224 mg IV over 15 to 30 minutes immediately before Cyclophosphamide (Cytoxan) infusion, and again 4 and 8 hours after the start of Cyclophosphamide (Cytoxan) infusion
  • 0.35-0.39 m² BSA: 288 mg IV over 15 to 30 minutes immediately before Cyclophosphamide (Cytoxan) infusion, and again 4 and 8 hours after the start of Cyclophosphamide (Cytoxan) infusion
  • 0.4-0.44 m² BSA: 352 mg IV over 15 to 30 minutes immediately before Cyclophosphamide (Cytoxan) infusion, and again 4 and 8 hours after the start of Cyclophosphamide (Cytoxan) infusion
  • 0.45-0.49 m² BSA: 416 mg IV over 15 to 30 minutes immediately before Cyclophosphamide (Cytoxan) infusion, and again 4 and 8 hours after the start of Cyclophosphamide (Cytoxan) infusion
  • 0.5-0.54 m² BSA: 480 mg IV over 15 to 30 minutes immediately before Cyclophosphamide (Cytoxan) infusion, and again 4 and 8 hours after the start of Cyclophosphamide (Cytoxan) infusion
  • 0.55-0.59 m² BSA: 528 mg IV over 15 to 30 minutes immediately before Cyclophosphamide (Cytoxan) infusion, and again 4 and 8 hours after the start of Cyclophosphamide (Cytoxan) infusion
  • ≥ 0.6 m² BSA: 960 mg/m² IV over 15 to 30 minutes immediately before Cyclophosphamide (Cytoxan) infusion, and again 4 and 8 hours after the start of Cyclophosphamide (Cytoxan) infusion

• Irinotecan (Camptosar) by the following BSA-based criteria:
  • 0.25-0.29 m² BSA: 8 mg IV over 90 minutes once daily on days 1 through 5 of weeks 4 and 10
  • 0.3-0.34 m² BSA: 12 mg IV over 90 minutes once daily on days 1 through 5 of weeks 4 and 10
  • 0.35-0.39 m² BSA: 15 mg IV over 90 minutes once daily on days 1 through 5 of weeks 4 and 10
  • 0.4-0.44 m² BSA: 18 mg IV over 90 minutes once daily on days 1 through 5 of weeks 4 and 10
  • 0.45-0.49 m² BSA: 22 mg IV over 90 minutes once daily on days 1 through 5 of weeks 4 and 10
  • 0.5-0.54 m² BSA: 24 mg IV over 90 minutes once daily on days 1 through 5 of weeks 4 and 10
  • 0.55-0.59 m² BSA: 28 mg IV over 90 minutes once daily on days 1 through 5 of weeks 4 and 10
  • ≥ 0.6 m² BSA: 50 mg/m² IV over 90 minutes once daily on days 1 through 5 of weeks 4 and 10

Cycles 5-10 (Weeks 13 through 30)

Chemotherapy

• Vincristine (Oncovin) by the following BSA-based criteria:
  • 0.25-0.29 m² BSA: 0.24 mg IV push over 1 minute (or infusion via minibag as per institutional policy once weekly on day 1 of weeks 13, 16, 17, 19, 20, 22 through 26, 28
  • 0.3-0.34 m² BSA: 0.34 mg IV push over 1 minute (or infusion via minibag as per institutional policy once weekly on day 1 of weeks 13, 16, 17, 19, 20, 22 through 26, 28
  • 0.35-0.39 m² BSA: 0.44 mg IV push over 1 minute (or infusion via minibag as per institutional policy once weekly on day 1 of weeks 13, 16, 17, 19, 20, 22 through 26, 28
  • 0.4-0.44 m² BSA: 0.55 mg IV push over 1 minute (or infusion via minibag as per institutional policy once weekly on day 1 of weeks 13, 16, 17, 19, 20, 22 through 26, 28
  • 0.45-0.49 m² BSA: 0.65 mg IV push over 1 minute (or infusion via minibag as per institutional policy once weekly on day 1 of weeks 13, 16, 17, 19, 20, 22 through 26, 28
  • 0.5-0.54 m² BSA: 0.74 mg IV push over 1 minute (or infusion via minibag as per institutional policy once weekly on day 1 of weeks 13, 16, 17, 19, 20, 22 through 26, 28
  • 0.55-0.59 m² BSA: 0.8 mg IV push over 1 minute (or infusion via minibag as per institutional policy once weekly on day 1 of weeks 13, 16, 17, 19, 20, 22 through 26, 28
  • ≥ 0.6 m² BSA: 1.5 mg/m² (maximum dose of 2 mg) IV push over 1 minute (or infusion via minibag as per institutional policy once weekly on day 1 of weeks 13, 16, 17, 19, 20, 22 through 26, 28

• Dactinomycin (Cosmegen) by the following weight-based criteria:
  • 3-4.5 kg: 0.09 mg slow IV push over 1 to 5 minutes or IV infusion over 10 to 15 minutes on day 1 of weeks 13, 22, 28
  • 4.6-6 kg: 0.14 mg slow IV push over 1 to 5 minutes or IV infusion over 10 to 15 minutes on day 1 of weeks 13, 22, 28
  • 6.1-7.3 kg: 0.21 mg slow IV push over 1 to 5 minutes or IV infusion over 10 to 15 minutes on day 1 of weeks 13, 22, 28
  • 7.4-8.6 kg: 0.26 mg slow IV push over 1 to 5 minutes or IV infusion over 10 to 15 minutes on day 1 of weeks 13, 22, 28
  • 8.7-9.9 kg: 0.33 mg slow IV push over 1 to 5 minutes or IV infusion over 10 to 15 minutes on day 1 of weeks 13, 22, 28
  • 10-11.2 kg: 0.4 mg slow IV push over 1 to 5 minutes or IV infusion over 10 to 15 minutes on day 1 of weeks 13, 22, 28
  • 11.3-12.5 kg: 0.5 mg slow IV push over 1 to 5 minutes or IV infusion over 10 to 15 minutes on day 1 of weeks 13, 22, 28
  • 12.6-13.9 kg: 0.6 mg slow IV push over 1 to 5 minutes or IV infusion over 10 to 15 minutes on day 1 of weeks 13, 22, 28
  • ≥14 kg: 0.05 mg/kg (maximum dose of 2.5 mg) slow IV push over 1 to 5 minutes or IV infusion over 10 to 15 minutes on day 1 of weeks 13, 22, 28

• Cyclophosphamide (Cytoxan) by the following BSA-based criteria:
  • 0.25-0.29 m² BSA: 220 mg IV over 60 minutes on day 1 of weeks 13, 22, 28
  • 0.3-0.34 m² BSA: 280 mg IV over 60 minutes on day 1 of weeks 13, 22, 28
  • 0.35-0.39 m² BSA: 360 mg IV over 60 minutes on day 1 of weeks 13, 22, 28
  • 0.4-0.44 m² BSA: 440 mg IV over 60 minutes on day 1 of weeks 13, 22, 28
  • 0.45-0.49 m² BSA: 520 mg IV over 60 minutes on day 1 of weeks 13, 22, 28
  • 0.5-0.54 m² BSA: 600 mg IV over 60 minutes on day 1 of weeks 13, 22, 28
  • 0.55-0.59 m² BSA: 660 mg IV over 60 minutes on day 1 of weeks 13, 22, 28
  • ≥ 0.6 m² BSA: 1200 mg/m² IV over 60 minutes on day 1 of weeks 13, 22, 28

• Mesna (Mesnex) by the following BSA-based criteria:

Mesna (Mesnex) can also be given PO at twice the IV dose

• • 0.25-0.29 m² BSA: 176 mg IV over 15 to 30 minutes immediately before Cyclophosphamide (Cytoxan) infusion, and again 4 and 8 hours after the start of Cyclophosphamide (Cytoxan) infusion
  • 0.3-0.34 m² BSA: 224 mg IV over 15 to 30 minutes immediately before Cyclophosphamide (Cytoxan) infusion, and again 4 and 8 hours after the start of Cyclophosphamide (Cytoxan) infusion
  • 0.35-0.39 m² BSA: 288 mg IV over 15 to 30 minutes immediately before Cyclophosphamide (Cytoxan) infusion, and again 4 and 8 hours after the start of Cyclophosphamide (Cytoxan) infusion
  • 0.4-0.44 m² BSA: 352 mg IV over 15 to 30 minutes immediately before Cyclophosphamide (Cytoxan) infusion, and again 4 and 8 hours after the start of Cyclophosphamide (Cytoxan) infusion
  • 0.45-0.49 m² BSA: 416 mg IV over 15 to 30 minutes immediately before Cyclophosphamide (Cytoxan) infusion, and again 4 and 8 hours after the start of Cyclophosphamide (Cytoxan) infusion
  • 0.5-0.54 m² BSA: 480 mg IV over 15 to 30 minutes immediately before Cyclophosphamide (Cytoxan) infusion, and again 4 and 8 hours after the start of Cyclophosphamide (Cytoxan) infusion
  • 0.55-0.59 m² BSA: 528 mg IV over 15 to 30 minutes immediately before Cyclophosphamide (Cytoxan) infusion, and again 4 and 8 hours after the start of Cyclophosphamide (Cytoxan) infusion
  • ≥ 0.6 m² BSA: 960 mg/m² IV over 15 to 30 minutes immediately before Cyclophosphamide (Cytoxan) infusion, and again 4 and 8 hours after the start of Cyclophosphamide (Cytoxan) infusion

• Irinotecan (Camptosar) by the following BSA-based criteria:
  • 0.25-0.29 m² BSA: 8 mg IV over 90 minutes once daily on days 1 through 5 of weeks 16, 19, 25
  • 0.3-0.34 m² BSA: 12 mg IV over 90 minutes once daily on days 1 through 5 of weeks 16, 19, 25
  • 0.35-0.39 m² BSA: 15 mg IV over 90 minutes once daily on days 1 through 5 of weeks 16, 19, 25
  • 0.4-0.44 m² BSA: 18 mg IV over 90 minutes once daily on days 1 through 5 of weeks 16, 19, 25
  • 0.45-0.49 m² BSA: 22 mg IV over 90 minutes once daily on days 1 through 5 of weeks 16, 19, 25
  • 0.5-0.54 m² BSA: 24 mg IV over 90 minutes once daily on days 1 through 5 of weeks 16, 19, 25
  • 0.55-0.59 m² BSA: 28 mg IV over 90 minutes once daily on days 1 through 5 of weeks 16, 19, 25
  • ≥ 0.6 m² BSA: 50 mg/m² IV over 90 minutes once daily on days 1 through 5 of weeks 16, 19, 25

Cycles 11-14 (Weeks 31 through 42)

Chemotherapy

• Vincristine (Oncovin) by the following BSA-based criteria:
  • 0.25-0.29 m² BSA: 0.24 mg IV push over 1 minute (or infusion via minibag as per institutional policy once weekly on day 1 of weeks 31 through 34, 37, 38, 40
  • 0.3-0.34 m² BSA: 0.34 mg IV push over 1 minute (or infusion via minibag as per institutional policy once weekly on day 1 of weeks 31 through 34, 37, 38, 40
  • 0.35-0.39 m² BSA: 0.44 mg IV push over 1 minute (or infusion via minibag as per institutional policy once weekly on day 1 of weeks 31 through 34, 37, 38, 40
  • 0.4-0.44 m² BSA: 0.55 mg IV push over 1 minute (or infusion via minibag as per institutional policy once weekly on day 1 of weeks 31 through 34, 37, 38, 40
  • 0.45-0.49 m² BSA: 0.65 mg IV push over 1 minute (or infusion via minibag as per institutional policy once weekly on day 1 of weeks 31 through 34, 37, 38, 40
  • 0.5-0.54 m² BSA: 0.74 mg IV push over 1 minute (or infusion via minibag as per institutional policy once weekly on day 1 of weeks 31 through 34, 37, 38, 40
  • 0.55-0.59 m² BSA: 0.8 mg IV push over 1 minute (or infusion via minibag as per institutional policy once weekly on day 1 of weeks 31 through 34, 37, 38, 40
  • ≥ 0.6 m² BSA: 1.5 mg/m² (maximum dose of 2 mg) IV push over 1 minute (or infusion via minibag as per institutional policy once weekly on day 1 of weeks 31 through 34, 37, 38, 40

• Dactinomycin (Cosmegen) by the following weight-based criteria:
  • 3-4.5 kg: 0.09 mg slow IV push over 1 to 5 minutes or IV infusion over 10 to 15 minutes on day 1 of weeks 34, 40
  • 4.6-6 kg: 0.14 mg slow IV push over 1 to 5 minutes or IV infusion over 10 to 15 minutes on day 1 of weeks 34, 40
  • 6.1-7.3 kg: 0.21 mg slow IV push over 1 to 5 minutes or IV infusion over 10 to 15 minutes on day 1 of weeks 34, 40
  • 7.4-8.6 kg: 0.26 mg slow IV push over 1 to 5 minutes or IV infusion over 10 to 15 minutes on day 1 of weeks 34, 40
  • 8.7-9.9 kg: 0.33 mg slow IV push over 1 to 5 minutes or IV infusion over 10 to 15 minutes on day 1 of weeks 34, 40
  • 10-11.2 kg: 0.4 mg slow IV push over 1 to 5 minutes or IV infusion over 10 to 15 minutes on day 1 of weeks 34, 40
  • 11.3-12.5 kg: 0.5 mg slow IV push over 1 to 5 minutes or IV infusion over 10 to 15 minutes on day 1 of weeks 34, 40
  • 12.6-13.9 kg: 0.6 mg slow IV push over 1 to 5 minutes or IV infusion over 10 to 15 minutes on day 1 of weeks 34, 40
  • ≥14 kg: 0.05 mg/kg (maximum dose of 2.5 mg) slow IV push over 1 to 5 minutes or IV infusion over 10 to 15 minutes on day 1 of weeks 34, 40

• Cyclophosphamide (Cytoxan) by the following BSA-based criteria:
  • 0.25-0.29 m² BSA: 220 mg IV over 60 minutes on day 1 of weeks 34, 40
  • 0.3-0.34 m² BSA: 280 mg IV over 60 minutes on day 1 of weeks 34, 40
  • 0.35-0.39 m² BSA: 360 mg IV over 60 minutes on day 1 of weeks 34, 40
  • 0.4-0.44 m² BSA: 440 mg IV over 60 minutes on day 1 of weeks 34, 40
  • 0.45-0.49 m² BSA: 520 mg IV over 60 minutes on day 1 of weeks 34, 40
  • 0.5-0.54 m² BSA: 600 mg IV over 60 minutes on day 1 of weeks 34, 40
  • 0.55-0.59 m² BSA: 660 mg IV over 60 minutes on day 1 of weeks 34, 40
  • ≥ 0.6 m² BSA: 1200 mg/m² IV over 60 minutes on day 1 of weeks 34, 40

• Mesna (Mesnex) by the following BSA-based criteria:

Mesna (Mesnex) can also be given PO at twice the IV dose

• • 0.25-0.29 m² BSA: 176 mg IV over 15 to 30 minutes immediately before Cyclophosphamide (Cytoxan) infusion, and again 4 and 8 hours after the start of Cyclophosphamide (Cytoxan) infusion
  • 0.3-0.34 m² BSA: 224 mg IV over 15 to 30 minutes immediately before Cyclophosphamide (Cytoxan) infusion, and again 4 and 8 hours after the start of Cyclophosphamide (Cytoxan) infusion
  • 0.35-0.39 m² BSA: 288 mg IV over 15 to 30 minutes immediately before Cyclophosphamide (Cytoxan) infusion, and again 4 and 8 hours after the start of Cyclophosphamide (Cytoxan) infusion
  • 0.4-0.44 m² BSA: 352 mg IV over 15 to 30 minutes immediately before Cyclophosphamide (Cytoxan) infusion, and again 4 and 8 hours after the start of Cyclophosphamide (Cytoxan) infusion
  • 0.45-0.49 m² BSA: 416 mg IV over 15 to 30 minutes immediately before Cyclophosphamide (Cytoxan) infusion, and again 4 and 8 hours after the start of Cyclophosphamide (Cytoxan) infusion
  • 0.5-0.54 m² BSA: 480 mg IV over 15 to 30 minutes immediately before Cyclophosphamide (Cytoxan) infusion, and again 4 and 8 hours after the start of Cyclophosphamide (Cytoxan) infusion
  • 0.55-0.59 m² BSA: 528 mg IV over 15 to 30 minutes immediately before Cyclophosphamide (Cytoxan) infusion, and again 4 and 8 hours after the start of Cyclophosphamide (Cytoxan) infusion
  • ≥ 0.6 m² BSA: 960 mg/m² IV over 15 to 30 minutes immediately before Cyclophosphamide (Cytoxan) infusion, and again 4 and 8 hours after the start of Cyclophosphamide (Cytoxan) infusion

• Irinotecan (Camptosar) by the following BSA-based criteria:
  • 0.25-0.29 m² BSA: 8 mg IV over 90 minutes once daily on days 1 through 5 of weeks 31, 37
  • 0.3-0.34 m² BSA: 12 mg IV over 90 minutes once daily on days 1 through 5 of weeks 31, 37
  • 0.35-0.39 m² BSA: 15 mg IV over 90 minutes once daily on days 1 through 5 of weeks 31, 37
  • 0.4-0.44 m² BSA: 18 mg IV over 90 minutes once daily on days 1 through 5 of weeks 31, 37
  • 0.45-0.49 m² BSA: 22 mg IV over 90 minutes once daily on days 1 through 5 of weeks 31, 37
  • 0.5-0.54 m² BSA: 24 mg IV over 90 minutes once daily on days 1 through 5 of weeks 31, 37
  • 0.55-0.59 m² BSA: 28 mg IV over 90 minutes once daily on days 1 through 5 of weeks 31, 37
  • ≥ 0.6 m² BSA: 50 mg/m² IV over 90 minutes once daily on days 1 through 5 of weeks 31, 37

Maintenance Cycles 1-6

Chemotherapy

• Vinorelbine (Navelbine) by the following BSA-based criteria:
  • 0.25-0.29 m² BSA: 4 mg IV push over 6 to 10 minutes on days 1, 8, and 15
  • 0.3-0.34 m² BSA: 6 mg IV push over 6 to 10 minutes on days 1, 8, and 15
  • 0.35-0.39 m² BSA: 7.5 mg IV push over 6 to 10 minutes on days 1, 8, and 15
  • 0.4-0.44 m² BSA: 9 mg IV push over 6 to 10 minutes on days 1, 8, and 15
  • 0.45-0.49 m² BSA: 11 mg IV push over 6 to 10 minutes on days 1, 8, and 15
  • 0.5-0.54 m² BSA: 12 mg IV push over 6 to 10 minutes on days 1, 8, and 15
  • 0.55-0.59 m² BSA: 14 mg IV push over 6 to 10 minutes on days 1, 8, and 15
  • ≥ 0.6 m² BSA: 25 mg/m² IV push over 6 to 10 minutes on days 1, 8, and 15

• Cyclophosphamide (Cytoxan) 25 mg/m² PO once daily on days 1 through 28
  • Dose rounded to the nearest 25 mg capsule

28 day cycle

Regimen B (VAC/VI Plus TORI)

Cycles 1-4 (Weeks 1 through 12)

Chemotherapy

• Temsirolimus (Torisel) by the following weight-based criteria:
  • < 10 kg: 0.5 mg/kg IV over 30 to 60 minutes once weekly on day 1 of weeks 1 through 12
  • > 10 kg: 15 mg/m² (maximum dose of 25 mg) IV on day 1 of weeks 1 through 12

• Vincristine (Oncovin) by the following BSA-based criteria:
  • 0.25-0.29 m² BSA: 0.24 mg IV push over 1 minute (or infusion via minibag as per institutional policy once weekly on day 1 of weeks 1 through 12
  • 0.3-0.34 m² BSA: 0.34 mg IV push over 1 minute (or infusion via minibag as per institutional policy once weekly on day 1 of weeks 1 through 12
  • 0.35-0.39 m² BSA: 0.44 mg IV push over 1 minute (or infusion via minibag as per institutional policy once weekly on day 1 of weeks 1 through 12
  • 0.4-0.44 m² BSA: 0.55 mg IV push over 1 minute (or infusion via minibag as per institutional policy once weekly on day 1 of weeks 1 through 12
  • 0.45-0.49 m² BSA: 0.65 mg IV push over 1 minute (or infusion via minibag as per institutional policy once weekly on day 1 of weeks 1 through 12
  • 0.5-0.54 m² BSA: 0.74 mg IV push over 1 minute (or infusion via minibag as per institutional policy once weekly on day 1 of weeks 1 through 12
  • 0.55-0.59 m² BSA: 0.8 mg IV push over 1 minute (or infusion via minibag as per institutional policy once weekly on day 1 of weeks 1 through 12
  • ≥ 0.6 m² BSA: 1.5 mg/m² (maximum dose of 2 mg) IV push over 1 minute (or infusion via minibag as per institutional policy once weekly on day 1 of weeks 1 through 12

• Dactinomycin (Cosmegen) by the following weight-based criteria:
  • 3-4.5 kg: 0.09 mg slow IV push over 1 to 5 minutes or IV infusion over 10 to 15 minutes on day 1 of weeks 1 and 7
  • 4.6-6 kg: 0.14 mg slow IV push over 1 to 5 minutes or IV infusion over 10 to 15 minutes on day 1 of weeks 1 and 7
  • 6.1-7.3 kg: 0.21 mg slow IV push over 1 to 5 minutes or IV infusion over 10 to 15 minutes on day 1 of weeks 1 and 7
  • 7.4-8.6 kg: 0.26 mg slow IV push over 1 to 5 minutes or IV infusion over 10 to 15 minutes on day 1 of weeks 1 and 7
  • 8.7-9.9 kg: 0.33 mg slow IV push over 1 to 5 minutes or IV infusion over 10 to 15 minutes on day 1 of weeks 1 and 7
  • 10-11.2 kg: 0.4 mg slow IV push over 1 to 5 minutes or IV infusion over 10 to 15 minutes on day 1 of weeks 1 and 7
  • 11.3-12.5 kg: 0.5 mg slow IV push over 1 to 5 minutes or IV infusion over 10 to 15 minutes on day 1 of weeks 1 and 7
  • 12.6-13.9 kg: 0.6 mg slow IV push over 1 to 5 minutes or IV infusion over 10 to 15 minutes on day 1 of weeks 1 and 7
  • ≥14 kg: 0.05 mg/kg (maximum dose of 2.5 mg) slow IV push over 1 to 5 minutes or IV infusion over 10 to 15 minutes on day 1 of weeks 1 and 7

• Cyclophosphamide (Cytoxan) by the following BSA-based criteria:
  • 0.25-0.29 m² BSA: 220 mg IV over 60 minutes on day 1 of weeks 1 and 7
  • 0.3-0.34 m² BSA: 280 mg IV over 60 minutes on day 1 of weeks 1 and 7
  • 0.35-0.39 m² BSA: 360 mg IV over 60 minutes on day 1 of weeks 1 and 7
  • 0.4-0.44 m² BSA: 440 mg IV over 60 minutes on day 1 of weeks 1 and 7
  • 0.45-0.49 m² BSA: 520 mg IV over 60 minutes on day 1 of weeks 1 and 7
  • 0.5-0.54 m² BSA: 600 mg IV over 60 minutes on day 1 of weeks 1 and 7
  • 0.55-0.59 m² BSA: 660 mg IV over 60 minutes on day 1 of weeks 1 and 7
  • ≥ 0.6 m² BSA: 1200 mg/m² IV over 60 minutes on day 1 of weeks 1 and 7

• Mesna (Mesnex) by the following BSA-based criteria:

Mesna (Mesnex) can also be given PO at twice the IV dose

• • 0.25-0.29 m² BSA: 176 mg IV over 15 to 30 minutes immediately before Cyclophosphamide (Cytoxan) infusion, and again 4 and 8 hours after the start of Cyclophosphamide (Cytoxan) infusion
  • 0.3-0.34 m² BSA: 224 mg IV over 15 to 30 minutes immediately before Cyclophosphamide (Cytoxan) infusion, and again 4 and 8 hours after the start of Cyclophosphamide (Cytoxan) infusion
  • 0.35-0.39 m² BSA: 288 mg IV over 15 to 30 minutes immediately before Cyclophosphamide (Cytoxan) infusion, and again 4 and 8 hours after the start of Cyclophosphamide (Cytoxan) infusion
  • 0.4-0.44 m² BSA: 352 mg IV over 15 to 30 minutes immediately before Cyclophosphamide (Cytoxan) infusion, and again 4 and 8 hours after the start of Cyclophosphamide (Cytoxan) infusion
  • 0.45-0.49 m² BSA: 416 mg IV over 15 to 30 minutes immediately before Cyclophosphamide (Cytoxan) infusion, and again 4 and 8 hours after the start of Cyclophosphamide (Cytoxan) infusion
  • 0.5-0.54 m² BSA: 480 mg IV over 15 to 30 minutes immediately before Cyclophosphamide (Cytoxan) infusion, and again 4 and 8 hours after the start of Cyclophosphamide (Cytoxan) infusion
  • 0.55-0.59 m² BSA: 528 mg IV over 15 to 30 minutes immediately before Cyclophosphamide (Cytoxan) infusion, and again 4 and 8 hours after the start of Cyclophosphamide (Cytoxan) infusion
  • ≥ 0.6 m² BSA: 960 mg/m² IV over 15 to 30 minutes immediately before Cyclophosphamide (Cytoxan) infusion, and again 4 and 8 hours after the start of Cyclophosphamide (Cytoxan) infusion

• Irinotecan (Camptosar) by the following BSA-based criteria:
  • 0.25-0.29 m² BSA: 8 mg IV over 90 minutes once daily on days 1 through 5 of weeks 4 and 10
  • 0.3-0.34 m² BSA: 12 mg IV over 90 minutes once daily on days 1 through 5 of weeks 4 and 10
  • 0.35-0.39 m² BSA: 15 mg IV over 90 minutes once daily on days 1 through 5 of weeks 4 and 10
  • 0.4-0.44 m² BSA: 18 mg IV over 90 minutes once daily on days 1 through 5 of weeks 4 and 10
  • 0.45-0.49 m² BSA: 22 mg IV over 90 minutes once daily on days 1 through 5 of weeks 4 and 10
  • 0.5-0.54 m² BSA: 24 mg IV over 90 minutes once daily on days 1 through 5 of weeks 4 and 10
  • 0.55-0.59 m² BSA: 28 mg IV over 90 minutes once daily on days 1 through 5 of weeks 4 and 10
  • ≥ 0.6 m² BSA: 50 mg/m² IV over 90 minutes once daily on days 1 through 5 of weeks 4 and 10

Cycles 5-10 (Weeks 13 through 30)

Chemotherapy

• Temsirolimus (Torisel) by the following weight-based criteria:
  • < 10 kg: 0.5 mg/kg IV over 30 to 60 minutes once weekly on day 1 of weeks 21 through 30
  • > 10 kg: 15 mg/m² (maximum dose of 25 mg) IV on day 1 of weeks 21 through 30

• Vincristine (Oncovin) by the following BSA-based criteria:
  • 0.25-0.29 m² BSA: 0.24 mg IV push over 1 minute (or infusion via minibag as per institutional policy once weekly on day 1 of weeks 13, 16, 17, 19, 20, 22 through 26, 28
  • 0.3-0.34 m² BSA: 0.34 mg IV push over 1 minute (or infusion via minibag as per institutional policy once weekly on day 1 of weeks 13, 16, 17, 19, 20, 22 through 26, 28
  • 0.35-0.39 m² BSA: 0.44 mg IV push over 1 minute (or infusion via minibag as per institutional policy once weekly on day 1 of weeks 13, 16, 17, 19, 20, 22 through 26, 28
  • 0.4-0.44 m² BSA: 0.55 mg IV push over 1 minute (or infusion via minibag as per institutional policy once weekly on day 1 of weeks 13, 16, 17, 19, 20, 22 through 26, 28
  • 0.45-0.49 m² BSA: 0.65 mg IV push over 1 minute (or infusion via minibag as per institutional policy once weekly on day 1 of weeks 13, 16, 17, 19, 20, 22 through 26, 28
  • 0.5-0.54 m² BSA: 0.74 mg IV push over 1 minute (or infusion via minibag as per institutional policy once weekly on day 1 of weeks 13, 16, 17, 19, 20, 22 through 26, 28
  • 0.55-0.59 m² BSA: 0.8 mg IV push over 1 minute (or infusion via minibag as per institutional policy once weekly on day 1 of weeks 13, 16, 17, 19, 20, 22 through 26, 28
  • ≥ 0.6 m² BSA: 1.5 mg/m² (maximum dose of 2 mg) IV push over 1 minute (or infusion via minibag as per institutional policy once weekly on day 1 of weeks 13, 16, 17, 19, 20, 22 through 26, 28

• Dactinomycin (Cosmegen) by the following weight-based criteria:
  • 3-4.5 kg: 0.09 mg slow IV push over 1 to 5 minutes or IV infusion over 10 to 15 minutes on day 1 of weeks 13, 22, 28
  • 4.6-6 kg: 0.14 mg slow IV push over 1 to 5 minutes or IV infusion over 10 to 15 minutes on day 1 of weeks 13, 22, 28
  • 6.1-7.3 kg: 0.21 mg slow IV push over 1 to 5 minutes or IV infusion over 10 to 15 minutes on day 1 of weeks 13, 22, 28
  • 7.4-8.6 kg: 0.26 mg slow IV push over 1 to 5 minutes or IV infusion over 10 to 15 minutes on day 1 of weeks 13, 22, 28
  • 8.7-9.9 kg: 0.33 mg slow IV push over 1 to 5 minutes or IV infusion over 10 to 15 minutes on day 1 of weeks 13, 22, 28
  • 10-11.2 kg: 0.4 mg slow IV push over 1 to 5 minutes or IV infusion over 10 to 15 minutes on day 1 of weeks 13, 22, 28
  • 11.3-12.5 kg: 0.5 mg slow IV push over 1 to 5 minutes or IV infusion over 10 to 15 minutes on day 1 of weeks 13, 22, 28
  • 12.6-13.9 kg: 0.6 mg slow IV push over 1 to 5 minutes or IV infusion over 10 to 15 minutes on day 1 of weeks 13, 22, 28
  • ≥14 kg: 0.05 mg/kg (maximum dose of 2.5 mg) slow IV push over 1 to 5 minutes or IV infusion over 10 to 15 minutes on day 1 of weeks 13, 22, 28

Give week 13 dose of Dactinomycin (Cosmegen) before beginning radiation therapy

• Cyclophosphamide (Cytoxan) by the following BSA-based criteria:
  • 0.25-0.29 m² BSA: 220 mg IV over 60 minutes on day 1 of weeks 13, 22, 28
  • 0.3-0.34 m² BSA: 280 mg IV over 60 minutes on day 1 of weeks 13, 22, 28
  • 0.35-0.39 m² BSA: 360 mg IV over 60 minutes on day 1 of weeks 13, 22, 28
  • 0.4-0.44 m² BSA: 440 mg IV over 60 minutes on day 1 of weeks 13, 22, 28
  • 0.45-0.49 m² BSA: 520 mg IV over 60 minutes on day 1 of weeks 13, 22, 28
  • 0.5-0.54 m² BSA: 600 mg IV over 60 minutes on day 1 of weeks 13, 22, 28
  • 0.55-0.59 m² BSA: 660 mg IV over 60 minutes on day 1 of weeks 13, 22, 28
  • ≥ 0.6 m² BSA: 1200 mg/m² IV over 60 minutes on day 1 of weeks 13, 22, 28

• Mesna (Mesnex) by the following BSA-based criteria:

Mesna (Mesnex) can also be given PO at twice the IV dose

• • 0.25-0.29 m² BSA: 176 mg IV over 15 to 30 minutes immediately before Cyclophosphamide (Cytoxan) infusion, and again 4 and 8 hours after the start of Cyclophosphamide (Cytoxan) infusion
  • 0.3-0.34 m² BSA: 224 mg IV over 15 to 30 minutes immediately before Cyclophosphamide (Cytoxan) infusion, and again 4 and 8 hours after the start of Cyclophosphamide (Cytoxan) infusion
  • 0.35-0.39 m² BSA: 288 mg IV over 15 to 30 minutes immediately before Cyclophosphamide (Cytoxan) infusion, and again 4 and 8 hours after the start of Cyclophosphamide (Cytoxan) infusion
  • 0.4-0.44 m² BSA: 352 mg IV over 15 to 30 minutes immediately before Cyclophosphamide (Cytoxan) infusion, and again 4 and 8 hours after the start of Cyclophosphamide (Cytoxan) infusion
  • 0.45-0.49 m² BSA: 416 mg IV over 15 to 30 minutes immediately before Cyclophosphamide (Cytoxan) infusion, and again 4 and 8 hours after the start of Cyclophosphamide (Cytoxan) infusion
  • 0.5-0.54 m² BSA: 480 mg IV over 15 to 30 minutes immediately before Cyclophosphamide (Cytoxan) infusion, and again 4 and 8 hours after the start of Cyclophosphamide (Cytoxan) infusion
  • 0.55-0.59 m² BSA: 528 mg IV over 15 to 30 minutes immediately before Cyclophosphamide (Cytoxan) infusion, and again 4 and 8 hours after the start of Cyclophosphamide (Cytoxan) infusion
  • ≥ 0.6 m² BSA: 960 mg/m² IV over 15 to 30 minutes immediately before Cyclophosphamide (Cytoxan) infusion, and again 4 and 8 hours after the start of Cyclophosphamide (Cytoxan) infusion

• Irinotecan (Camptosar) by the following BSA-based criteria:
  • 0.25-0.29 m² BSA: 8 mg IV over 90 minutes once daily on days 1 through 5 of weeks 16, 19, 25
  • 0.3-0.34 m² BSA: 12 mg IV over 90 minutes once daily on days 1 through 5 of weeks 16, 19, 25
  • 0.35-0.39 m² BSA: 15 mg IV over 90 minutes once daily on days 1 through 5 of weeks 16, 19, 25
  • 0.4-0.44 m² BSA: 18 mg IV over 90 minutes once daily on days 1 through 5 of weeks 16, 19, 25
  • 0.45-0.49 m² BSA: 22 mg IV over 90 minutes once daily on days 1 through 5 of weeks 16, 19, 25
  • 0.5-0.54 m² BSA: 24 mg IV over 90 minutes once daily on days 1 through 5 of weeks 16, 19, 25
  • 0.55-0.59 m² BSA: 28 mg IV over 90 minutes once daily on days 1 through 5 of weeks 16, 19, 25
  • ≥ 0.6 m² BSA: 50 mg/m² IV over 90 minutes once daily on days 1 through 5 of weeks 16, 19, 25

Cycles 11-14 (Weeks 31 through 42)

Chemotherapy

• Temsirolimus (Torisel) by the following weight-based criteria:
  • < 10 kg: 0.5 mg/kg IV over 30 to 60 minutes once weekly on day 1 of weeks 31 through 42
  • > 10 kg: 15 mg/m² (maximum dose of 25 mg) IV on day 1 of weeks 31 through 42

• Vincristine (Oncovin) by the following BSA-based criteria:
  • 0.25-0.29 m² BSA: 0.24 mg IV push over 1 minute (or infusion via minibag as per institutional policy once weekly on day 1 of weeks 31 through 34, 37, 38, 40
  • 0.3-0.34 m² BSA: 0.34 mg IV push over 1 minute (or infusion via minibag as per institutional policy once weekly on day 1 of weeks 31 through 34, 37, 38, 40
  • 0.35-0.39 m² BSA: 0.44 mg IV push over 1 minute (or infusion via minibag as per institutional policy once weekly on day 1 of weeks 31 through 34, 37, 38, 40
  • 0.4-0.44 m² BSA: 0.55 mg IV push over 1 minute (or infusion via minibag as per institutional policy once weekly on day 1 of weeks 31 through 34, 37, 38, 40
  • 0.45-0.49 m² BSA: 0.65 mg IV push over 1 minute (or infusion via minibag as per institutional policy once weekly on day 1 of weeks 31 through 34, 37, 38, 40
  • 0.5-0.54 m² BSA: 0.74 mg IV push over 1 minute (or infusion via minibag as per institutional policy once weekly on day 1 of weeks 31 through 34, 37, 38, 40
  • 0.55-0.59 m² BSA: 0.8 mg IV push over 1 minute (or infusion via minibag as per institutional policy once weekly on day 1 of weeks 31 through 34, 37, 38, 40
  • ≥ 0.6 m² BSA: 1.5 mg/m² (maximum dose of 2 mg) IV push over 1 minute (or infusion via minibag as per institutional policy once weekly on day 1 of weeks 31 through 34, 37, 38, 40

• Dactinomycin (Cosmegen) by the following weight-based criteria:
  • 3-4.5 kg: 0.09 mg slow IV push over 1 to 5 minutes or IV infusion over 10 to 15 minutes on day 1 of weeks 34, 40
  • 4.6-6 kg: 0.14 mg slow IV push over 1 to 5 minutes or IV infusion over 10 to 15 minutes on day 1 of weeks 34, 40
  • 6.1-7.3 kg: 0.21 mg slow IV push over 1 to 5 minutes or IV infusion over 10 to 15 minutes on day 1 of weeks 34, 40
  • 7.4-8.6 kg: 0.26 mg slow IV push over 1 to 5 minutes or IV infusion over 10 to 15 minutes on day 1 of weeks 34, 40
  • 8.7-9.9 kg: 0.33 mg slow IV push over 1 to 5 minutes or IV infusion over 10 to 15 minutes on day 1 of weeks 34, 40
  • 10-11.2 kg: 0.4 mg slow IV push over 1 to 5 minutes or IV infusion over 10 to 15 minutes on day 1 of weeks 34, 40
  • 11.3-12.5 kg: 0.5 mg slow IV push over 1 to 5 minutes or IV infusion over 10 to 15 minutes on day 1 of weeks 34, 40
  • 12.6-13.9 kg: 0.6 mg slow IV push over 1 to 5 minutes or IV infusion over 10 to 15 minutes on day 1 of weeks 34, 40
  • ≥14 kg: 0.05 mg/kg (maximum dose of 2.5 mg) slow IV push over 1 to 5 minutes or IV infusion over 10 to 15 minutes on day 1 of weeks 34, 40

• Cyclophosphamide (Cytoxan) by the following BSA-based criteria:
  • 0.25-0.29 m² BSA: 220 mg IV over 60 minutes on day 1 of weeks 34, 40
  • 0.3-0.34 m² BSA: 280 mg IV over 60 minutes on day 1 of weeks 34, 40
  • 0.35-0.39 m² BSA: 360 mg IV over 60 minutes on day 1 of weeks 34, 40
  • 0.4-0.44 m² BSA: 440 mg IV over 60 minutes on day 1 of weeks 34, 40
  • 0.45-0.49 m² BSA: 520 mg IV over 60 minutes on day 1 of weeks 34, 40
  • 0.5-0.54 m² BSA: 600 mg IV over 60 minutes on day 1 of weeks 34, 40
  • 0.55-0.59 m² BSA: 660 mg IV over 60 minutes on day 1 of weeks 34, 40
  • ≥ 0.6 m² BSA: 1200 mg/m² IV over 60 minutes on day 1 of weeks 34, 40

• Mesna (Mesnex) by the following BSA-based criteria:

Mesna (Mesnex) can also be given PO at twice the IV dose

• • 0.25-0.29 m² BSA: 176 mg IV over 15 to 30 minutes immediately before Cyclophosphamide (Cytoxan) infusion, and again 4 and 8 hours after the start of Cyclophosphamide (Cytoxan) infusion
  • 0.3-0.34 m² BSA: 224 mg IV over 15 to 30 minutes immediately before Cyclophosphamide (Cytoxan) infusion, and again 4 and 8 hours after the start of Cyclophosphamide (Cytoxan) infusion
  • 0.35-0.39 m² BSA: 288 mg IV over 15 to 30 minutes immediately before Cyclophosphamide (Cytoxan) infusion, and again 4 and 8 hours after the start of Cyclophosphamide (Cytoxan) infusion
  • 0.4-0.44 m² BSA: 352 mg IV over 15 to 30 minutes immediately before Cyclophosphamide (Cytoxan) infusion, and again 4 and 8 hours after the start of Cyclophosphamide (Cytoxan) infusion
  • 0.45-0.49 m² BSA: 416 mg IV over 15 to 30 minutes immediately before Cyclophosphamide (Cytoxan) infusion, and again 4 and 8 hours after the start of Cyclophosphamide (Cytoxan) infusion
  • 0.5-0.54 m² BSA: 480 mg IV over 15 to 30 minutes immediately before Cyclophosphamide (Cytoxan) infusion, and again 4 and 8 hours after the start of Cyclophosphamide (Cytoxan) infusion
  • 0.55-0.59 m² BSA: 528 mg IV over 15 to 30 minutes immediately before Cyclophosphamide (Cytoxan) infusion, and again 4 and 8 hours after the start of Cyclophosphamide (Cytoxan) infusion
  • ≥ 0.6 m² BSA: 960 mg/m² IV over 15 to 30 minutes immediately before Cyclophosphamide (Cytoxan) infusion, and again 4 and 8 hours after the start of Cyclophosphamide (Cytoxan) infusion

• Irinotecan (Camptosar) by the following BSA-based criteria:
  • 0.25-0.29 m² BSA: 8 mg IV over 90 minutes once daily on days 1 through 5 of weeks 31, 37
  • 0.3-0.34 m² BSA: 12 mg IV over 90 minutes once daily on days 1 through 5 of weeks 31, 37
  • 0.35-0.39 m² BSA: 15 mg IV over 90 minutes once daily on days 1 through 5 of weeks 31, 37
  • 0.4-0.44 m² BSA: 18 mg IV over 90 minutes once daily on days 1 through 5 of weeks 31, 37
  • 0.45-0.49 m² BSA: 22 mg IV over 90 minutes once daily on days 1 through 5 of weeks 31, 37
  • 0.5-0.54 m² BSA: 24 mg IV over 90 minutes once daily on days 1 through 5 of weeks 31, 37
  • 0.55-0.59 m² BSA: 28 mg IV over 90 minutes once daily on days 1 through 5 of weeks 31, 37
  • ≥ 0.6 m² BSA: 50 mg/m² IV over 90 minutes once daily on days 1 through 5 of weeks 31, 37

Maintenance Cycles 1-6

Chemotherapy

• Vinorelbine (Navelbine) by the following BSA-based criteria:
  • 0.25-0.29 m² BSA: 4 mg IV push over 6 to 10 minutes on days 1, 8, and 15
  • 0.3-0.34 m² BSA: 6 mg IV push over 6 to 10 minutes on days 1, 8, and 15
  • 0.35-0.39 m² BSA: 7.5 mg IV push over 6 to 10 minutes on days 1, 8, and 15
  • 0.4-0.44 m² BSA: 9 mg IV push over 6 to 10 minutes on days 1, 8, and 15
  • 0.45-0.49 m² BSA: 11 mg IV push over 6 to 10 minutes on days 1, 8, and 15
  • 0.5-0.54 m² BSA: 12 mg IV push over 6 to 10 minutes on days 1, 8, and 15
  • 0.55-0.59 m² BSA: 14 mg IV push over 6 to 10 minutes on days 1, 8, and 15
  • ≥ 0.6 m² BSA: 25 mg/m² IV push over 6 to 10 minutes on days 1, 8, and 15

• Cyclophosphamide (Cytoxan) 25 mg/m² PO once daily on days 1 through 28
  • Dose rounded to the nearest 25 mg capsule

28 day cycle

Regimen C (VAC/VA Only)

Cycles 1-4 (Weeks 1 through 12)

Chemotherapy

• Vincristine (Oncovin) by the following BSA-based criteria:
  • 0.25-0.29 m² BSA: 0.24 mg IV push over 1 minute (or infusion via minibag as per institutional policy once weekly on day 1 of weeks 1 through 10
  • 0.3-0.34 m² BSA: 0.34 mg IV push over 1 minute (or infusion via minibag as per institutional policy once weekly on day 1 of weeks 1 through 10
  • 0.35-0.39 m² BSA: 0.44 mg IV push over 1 minute (or infusion via minibag as per institutional policy once weekly on day 1 of weeks 1 through 10
  • 0.4-0.44 m² BSA: 0.55 mg IV push over 1 minute (or infusion via minibag as per institutional policy once weekly on day 1 of weeks 1 through 10
  • 0.45-0.49 m² BSA: 0.65 mg IV push over 1 minute (or infusion via minibag as per institutional policy once weekly on day 1 of weeks 1 through 10
  • 0.5-0.54 m² BSA: 0.74 mg IV push over 1 minute (or infusion via minibag as per institutional policy once weekly on day 1 of weeks 1 through 10
  • 0.55-0.59 m² BSA: 0.8 mg IV push over 1 minute (or infusion via minibag as per institutional policy once weekly on day 1 of weeks 1 through 10
  • ≥ 0.6 m² BSA: 1.5 mg/m² (maximum dose of 2 mg) IV push over 1 minute (or infusion via minibag as per institutional policy once weekly on day 1 of weeks 1 through 10

• Dactinomycin (Cosmegen) by the following weight-based criteria:
  • 3-4.5 kg: 0.09 mg slow IV push over 1 to 5 minutes or IV infusion over 10 to 15 minutes on day 1 of weeks 1, 4, 7, 10
  • 4.6-6 kg: 0.14 mg slow IV push over 1 to 5 minutes or IV infusion over 10 to 15 minutes on day 1 of weeks 1, 4, 7, 10
  • 6.1-7.3 kg: 0.21 mg slow IV push over 1 to 5 minutes or IV infusion over 10 to 15 minutes on day 1 of weeks 1, 4, 7, 10
  • 7.4-8.6 kg: 0.26 mg slow IV push over 1 to 5 minutes or IV infusion over 10 to 15 minutes on day 1 of weeks 1, 4, 7, 10
  • 8.7-9.9 kg: 0.33 mg slow IV push over 1 to 5 minutes or IV infusion over 10 to 15 minutes on day 1 of weeks 1, 4, 7, 10
  • 10-11.2 kg: 0.4 mg slow IV push over 1 to 5 minutes or IV infusion over 10 to 15 minutes on day 1 of weeks 1, 4, 7, 10
  • 11.3-12.5 kg: 0.5 mg slow IV push over 1 to 5 minutes or IV infusion over 10 to 15 minutes on day 1 of weeks 1, 4, 7, 10
  • 12.6-13.9 kg: 0.6 mg slow IV push over 1 to 5 minutes or IV infusion over 10 to 15 minutes on day 1 of weeks 1, 4, 7, 10
  • ≥14 kg: 0.05 mg/kg (maximum dose of 2.5 mg) slow IV push over 1 to 5 minutes or IV infusion over 10 to 15 minutes on day 1 of weeks 1, 4, 7, 10

• Cyclophosphamide (Cytoxan) by the following BSA-based criteria:
  • 0.25-0.29 m² BSA: 220 mg IV over 60 minutes on day 1 of weeks 1, 4, 7, 10
  • 0.3-0.34 m² BSA: 280 mg IV over 60 minutes on day 1 of weeks 1, 4, 7, 10
  • 0.35-0.39 m² BSA: 360 mg IV over 60 minutes on day 1 of weeks 1, 4, 7, 10
  • 0.4-0.44 m² BSA: 440 mg IV over 60 minutes on day 1 of weeks 1, 4, 7, 10
  • 0.45-0.49 m² BSA: 520 mg IV over 60 minutes on day 1 of weeks 1, 4, 7, 10
  • 0.5-0.54 m² BSA: 600 mg IV over 60 minutes on day 1 of weeks 1, 4, 7, 10
  • 0.55-0.59 m² BSA: 660 mg IV over 60 minutes on day 1 of weeks 1, 4, 7, 10
  • ≥ 0.6 m² BSA: 1200 mg/m² IV over 60 minutes on day 1 of weeks 1, 4, 7, 10

• Mesna (Mesnex) by the following BSA-based criteria:

Mesna (Mesnex) can also be given PO at twice the IV dose

• • 0.25-0.29 m² BSA: 176 mg IV over 15 to 30 minutes immediately before Cyclophosphamide (Cytoxan) infusion, and again 4 and 8 hours after the start of Cyclophosphamide (Cytoxan) infusion
  • 0.3-0.34 m² BSA: 224 mg IV over 15 to 30 minutes immediately before Cyclophosphamide (Cytoxan) infusion, and again 4 and 8 hours after the start of Cyclophosphamide (Cytoxan) infusion
  • 0.35-0.39 m² BSA: 288 mg IV over 15 to 30 minutes immediately before Cyclophosphamide (Cytoxan) infusion, and again 4 and 8 hours after the start of Cyclophosphamide (Cytoxan) infusion
  • 0.4-0.44 m² BSA: 352 mg IV over 15 to 30 minutes immediately before Cyclophosphamide (Cytoxan) infusion, and again 4 and 8 hours after the start of Cyclophosphamide (Cytoxan) infusion
  • 0.45-0.49 m² BSA: 416 mg IV over 15 to 30 minutes immediately before Cyclophosphamide (Cytoxan) infusion, and again 4 and 8 hours after the start of Cyclophosphamide (Cytoxan) infusion
  • 0.5-0.54 m² BSA: 480 mg IV over 15 to 30 minutes immediately before Cyclophosphamide (Cytoxan) infusion, and again 4 and 8 hours after the start of Cyclophosphamide (Cytoxan) infusion
  • 0.55-0.59 m² BSA: 528 mg IV over 15 to 30 minutes immediately before Cyclophosphamide (Cytoxan) infusion, and again 4 and 8 hours after the start of Cyclophosphamide (Cytoxan) infusion
  • ≥ 0.6 m² BSA: 960 mg/m² IV over 15 to 30 minutes immediately before Cyclophosphamide (Cytoxan) infusion, and again 4 and 8 hours after the start of Cyclophosphamide (Cytoxan) infusion

Cycles 5-8 (Weeks 13 through 24)

Chemotherapy

• Vincristine (Oncovin) by the following BSA-based criteria:
  • 0.25-0.29 m² BSA: 0.24 mg IV push over 1 minute (or infusion via minibag as per institutional policy once weekly on day 1 of weeks 13 through 22
  • 0.3-0.34 m² BSA: 0.34 mg IV push over 1 minute (or infusion via minibag as per institutional policy once weekly on day 1 of weeks 13 through 22
  • 0.35-0.39 m² BSA: 0.44 mg IV push over 1 minute (or infusion via minibag as per institutional policy once weekly on day 1 of weeks 13 through 22
  • 0.4-0.44 m² BSA: 0.55 mg IV push over 1 minute (or infusion via minibag as per institutional policy once weekly on day 1 of weeks 13 through 22
  • 0.45-0.49 m² BSA: 0.65 mg IV push over 1 minute (or infusion via minibag as per institutional policy once weekly on day 1 of weeks 13 through 22
  • 0.5-0.54 m² BSA: 0.74 mg IV push over 1 minute (or infusion via minibag as per institutional policy once weekly on day 1 of weeks 13 through 22
  • 0.55-0.59 m² BSA: 0.8 mg IV push over 1 minute (or infusion via minibag as per institutional policy once weekly on day 1 of weeks 13 through 22
  • ≥ 0.6 m² BSA: 1.5 mg/m² (maximum dose of 2 mg) IV push over 1 minute (or infusion via minibag as per institutional policy once weekly on day 1 of weeks 13 through 22

• Dactinomycin (Cosmegen) by the following weight-based criteria:
  • 3-4.5 kg: 0.09 mg slow IV push over 1 to 5 minutes or IV infusion over 10 to 15 minutes on day 1 of weeks 13, 16, 19, 22
  • 4.6-6 kg: 0.14 mg slow IV push over 1 to 5 minutes or IV infusion over 10 to 15 minutes on day 1 of weeks 13, 16, 19, 22
  • 6.1-7.3 kg: 0.21 mg slow IV push over 1 to 5 minutes or IV infusion over 10 to 15 minutes on day 1 of weeks 13, 16, 19, 22
  • 7.4-8.6 kg: 0.26 mg slow IV push over 1 to 5 minutes or IV infusion over 10 to 15 minutes on day 1 of weeks 13, 16, 19, 22
  • 8.7-9.9 kg: 0.33 mg slow IV push over 1 to 5 minutes or IV infusion over 10 to 15 minutes on day 1 of weeks 13, 16, 19, 22
  • 10-11.2 kg: 0.4 mg slow IV push over 1 to 5 minutes or IV infusion over 10 to 15 minutes on day 1 of weeks 13, 16, 19, 22
  • 11.3-12.5 kg: 0.5 mg slow IV push over 1 to 5 minutes or IV infusion over 10 to 15 minutes on day 1 of weeks 13, 16, 19, 22
  • 12.6-13.9 kg: 0.6 mg slow IV push over 1 to 5 minutes or IV infusion over 10 to 15 minutes on day 1 of weeks 13, 16, 19, 22
  • ≥14 kg: 0.05 mg/kg (maximum dose of 2.5 mg) slow IV push over 1 to 5 minutes or IV infusion over 10 to 15 minutes on day 1 of weeks 13, 16, 19, 22

COG ARST0431

IRIN-VCR (Weeks 1-6)

Week 1 (IRIN-VCR)

• 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

Week 2 (VCR)

• 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

Week 3 (VCR)

• 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

Week 4 (IRIN-VCR)

• 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

Week 5 (VCR)

• 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

Week 6

• Evaluation Week

VDC/IE (Weeks 7-19)

Week 7 (VDC)

• 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

Week 8 (VCR)

• 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

Week 9 (IE)

• 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

Week 10

• Off Chemotherapy Week

Week 11 (VDC)

• 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

Week 12 (VCR)

• 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

Week 13 (IE)

• 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

Week 14

• Off Chemotherapy Week

Week 15 (VDC)

• 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

Week 16 (VCR)

• 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

Week 17 (IE)

• 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

Week 18

• Off Chemotherapy Week

Week 19

• Evaluation Week

IRIN-VCR/IE/VDC (Weeks 20-34)

Week 20 (IRIN-VCR)

• 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

Week 21 (VCR)

• 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

Week 22 (VCR)

• 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

Week 23 (IRIN-VCR)

• 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

Week 24 (VCR)

• 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

Week 25

• Off Chemotherapy Week

Week 26 (IE)

• 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

Week 27

• Off Chemotherapy Week

Week 28 (VDC)

• 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

Week 29 (VCR)

• 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

Week 30 (IE)

• 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

Week 31

• Off Chemotherapy Week

Week 32 (VDC)

• 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

Week 33 (VCR)

• 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

Week 34

• Evaluation Week

VAC/IRIN-VCR (Weeks 35-54)

Week 35 (VAC)

• 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

Week 36

• Off Chemotherapy Week

Week 37

• Off Chemotherapy Week

Week 38 (VAC)

• 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

Week 39

• Off Chemotherapy Week

Week 40

• Off Chemotherapy Week

Week 41 (VAC)

• 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

Week 42 (VCR)

• 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

Week 43 (VCR)

• 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

Week 44 (VAC)

• 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

Week 45

• Off Chemotherapy Week

Week 46

• Off Chemotherapy Week

Week 47 (IRIN-VCR)

• 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

Week 48 (VCR)

• 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

Week 49

• Off Chemotherapy Week

Week 50 (IRIN-VCR)

• 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

Week 51 (VCR)

• 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

Week 52

• Off Chemotherapy Week

Week 53

• Off Chemotherapy Week

Week 54

• Evaluation Week

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