Ewing sarcoma, pediatric

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Upfront Therapy

COG AEWS1031

Regimen A Induction

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

Chemotherapy, VDC portion

• Vincristine (Oncovin) as follows:
  • Cycles 1, 3, 5: 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) as follows:
  • Cycles 1, 3, 5: 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) as follows:
  • Cycles 1, 3, 5: 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

Supportive therapy, VDC portion

• Mesna (Mesnex) as follows:
  • Cycles 1, 3, 5: 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

Chemotherapy, IE portion

• Ifosfamide (Ifex) as follows:
  • Cycles 2, 4, 6: 1800 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).
• Etoposide (Vepesid) as follows:
  • Cycles 2, 4, 6: 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

Supportive therapy, IE portion

• Mesna (Mesnex) as follows:
  • Cycles 2, 4, 6: 1080 mg/m²/day by IV infusion or IV/PO with ifosfamide 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

14-day cycle for 6 cycles