Difference between revisions of "Ewing sarcoma, pediatric"

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=Upfront Therapy=
 
=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/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===
 
*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 A<sub>2</sub>
 
*[[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'''
 
====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
 
**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'''
 
====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)
 
**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'''
 
====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)
 
**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'''
 
====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)
 
**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'''
 
====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)
 
**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'''
 
====Cycle 13 (VC)====
 
*[[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
 
*[[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'''
 
===Regimen B Induction===
 
*Regimen B is a consolidated regimen consisting of 14 day cycles
 
====Cycles 1, 3, & 5 (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
 
'''14 day cycle'''
 
====Cycle 2, 4, & 6 (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
 
'''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 B<sub>2</sub>
 
*[[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
 
'''14 day cycle'''
 
 
 
====Cycle 8, 10, 12, & 14 (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
 
'''14 day cycle'''
 
====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)
 
**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
 
'''14 day cycle'''
 
====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)
 
**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
 
'''14 day cycle'''
 
====Cycle 11 (VC)====
 
*[[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
 
*[[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
 
'''14 day cycle'''
 
====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)
 
**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
 
'''14 day cycle'''
 
====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)
 
**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
 
'''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. [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
 
 
 
 
==COG AEWS1031==
 
==COG AEWS1031==
 
===Regimen A Induction===
 
===Regimen A Induction===

Revision as of 10:53, 21 July 2022

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Upfront Therapy

COG AEWS1031

Regimen A Induction

  • Regimen A is a standard regimen consisting of 14 day cycles

Cycles 1, 3, & 5 (VDC)

  • Vincristine (Oncovin) 1.5 mg/m2/dose IV push once on day 1 of weeks 1, 2, 5, 6, 9 & 10 (maximum dose of 2 mg)
    • For children < 10 kg or < 1 year, the dose is 0.05 mg/kg/dose
  • Doxorubicin (Adriamycin) 37.5 mg/m2/dose IV push/infusion over 1-15 minutes on days 1 and 2 of weeks 1, 5 and 9.
    • For children < 10 kg or < 1 year, the dose is 1.25 mg/kg/dose
    • Administer at a concentration not to exceed 2 mg/mL. Doxorubicin (Adriamycin) should be administered through the tubing of rapidly infusing solution of D5W or 0.9% NaCl, and it should not be infused into a large vein
  • Cyclophosphamide (Cytoxan) 1200 mg/m2/dose IV over 30 to60 minutes on day 1 of weeks 1, 5 and 9
    • For children < 10 kg or < 1 year, the dose is 40 mg/kg/dose
    • May be administered as undiluted drug (20 mg/mL, reconstitute with 0.9% NaCl to avoid hypotonic solution) or further diluted
  • Mesna (Mesnex) 720 mg/m2/day by IV infusion or IV/PO with Cyclophosphamide (Cytoxan) on day 1 of weeks 1, 5 and 9
    • For children < 10 kg or < 1 year, the dose is 24 mg/kg/dose

14 day cycle

Cycles 2, 4, & 6 (IE)

  • Ifosfamide (Ifex) 1,800 mg/m2/dose IV infusion over 1 hour on days 1, 2, 3, 4, and 5 of Weeks 3, 7 and 11
    • For children < 10 kg or < 1 year, the dose is 60 mg/kg/dose
    • Achieve urine specific gravity ≤ 1.010 prior to start of Ifosfamide (Ifex).
  • Mesna (Mesnex) 1,080 mg/m2/day by IV infusion or IV/PO with Ifosfamide (Ifex) on days 1, 2, 3, 4, and 5 of Weeks 3, 7 and 11
    • For children < 10 kg or < 1 year, the dose is 36 mg/kg/dose
  • Etoposide (Vepesid) 100 mg/m2/dose IV infusion over 1 to 2 hours once on days 1, 2, 3, 4, and 5 of weeks 3, 7 and 11
    • For children < 10 kg or < 1 year, the dose is 3.3 mg/kg/dose

14 day cycle

Regimen A Consolidation

Regimen B Induction

Regimen B Consolidation