Rhabdomyosarcoma, pediatric

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Intermediate Risk

COG ARST1431 Protocol A (VAC/VI Only)

Protocol, 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

• 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

Supportive Medications

• Mesna (Mesnex) by the following BSA-based criteria:
  • 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
    • Mesna (Mesnex) can also be given PO at twice the IV dose

Protocol, 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
• 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

Supportive Medications

• Mesna (Mesnex) by the following BSA-based criteria:
  • 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
    • Mesna (Mesnex) can also be given PO at twice the IV dose

Protocol, 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
• 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

Supportive Medications

• Mesna (Mesnex) by the following BSA-based criteria:
  • 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
    • Mesna (Mesnex) can also be given PO at twice the IV dose

Protocol, 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

References

1. Vinorelbine and low dose cyclophosphamide maintenance therapy: Vinorelbine and low dose cyclophosphamide maintenance therapy: Bisogno G, De Salvo GL, Bergeron C, Gallego Melcons s, Merks JH, Kelsey A, Martelli H, Minard-Colin V, Orbach D, Glosli H, Chisholm J, Casanova M, Zanetti I, Devalck C, Ben-Arush M, Mudry P, Ferman S, Jenney M, Ferrari A. Vinorelbine and continuous low-dose cyclophosphamide as maintenance chemotherapy in patients with high-risk rhabdomyosarcoma (RMS 2005): a multicentre, open-label, randomised, phase 3 tial. Lancet Oncol. 2019 Nov;20(11):1566-1575. link to original article PubMed
2. COG ARST1431: NCT02567435

COG ARST1431 Protocol B (VAC/VI Plus TORI)

Protocol, 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
• 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

Supportive Medications

• 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

Protocol, 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
• 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

Supportive Medications

• 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

Protocol, 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
• 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

Supportive Medications

• 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

Protocol, 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

References

1. Vinorelbine and low dose cyclophosphamide maintenance therapy: Vinorelbine and low dose cyclophosphamide maintenance therapy: Bisogno G, De Salvo GL, Bergeron C, Gallego Melcons s, Merks JH, Kelsey A, Martelli H, Minard-Colin V, Orbach D, Glosli H, Chisholm J, Casanova M, Zanetti I, Devalck C, Ben-Arush M, Mudry P, Ferman S, Jenney M, Ferrari A. Vinorelbine and continuous low-dose cyclophosphamide as maintenance chemotherapy in patients with high-risk rhabdomyosarcoma (RMS 2005): a multicentre, open-label, randomised, phase 3 tial. Lancet Oncol. 2019 Nov;20(11):1566-1575. link to original article PubMed
2. COG ARST1431: NCT02567435

COG ARST0531 VAC Arm

Protocol, Weeks 1-15

Study	Years of enrollment	Evidence	Comparator	Comparative Efficacy
Hawkins et al. 2018 (COG ARST0531)	2006-2012	Phase 3 (E-switch-ic)	VAC/VI	Did not meet primary endpoint of EFS

Chemotherapy, Week 1

• 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

Supportive Medications, Week 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

Chemotherapy, Week 2

• 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

Chemotherapy, Week 3

• 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

Chemotherapy, Week 4

• Radiation therapy begins
• 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

Supportive Medications, Week 4

• 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

Chemotherapy, Week 5

• Radiation therapy continues
• 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

Chemotherapy, Week 6

• Radiation therapy continues
• 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

Chemotherapy, Week 7

• Radiation therapy continues
• 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
• 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

Supportive Medications, Week 7

• 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

Chemotherapy, Week 8

• Radiation therapy continues
• 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

Chemotherapy, Week 9

• Radiation therapy final week
• 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

Chemotherapy, Week 10

• 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
• 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

Supportive Medications, Week 10

• 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

Chemotherapy, Week 11

• 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

Chemotherapy, Week 12

• 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

Chemotherapy, Week 13

• 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

Supportive Medications, Week 13

• 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

Protocol, Weeks 16-30

Chemotherapy, Week 16

• 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

Supportive Medications, Week 16

• 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

Chemotherapy, Week 19

• 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

Supportive Medications, Week 19

• 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

Chemotherapy, Week 20

• 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

Chemotherapy, Week 21

• 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

Chemotherapy, Week 22

• 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

Supportive Medications, Week 22

• 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

Chemotherapy, Week 23

• 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

Chemotherapy, Week 24

• 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

Chemotherapy, Week 25

• 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

Supportive Medications, Week 25

• 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

Chemotherapy, Week 28

• 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

Supportive Medications, Week 28

• 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

Protocol, Weeks 31-43

Chemotherapy, Week 31

• 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

Supportive Medications, Week 31

• 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

Chemotherapy, Week 32

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

Chemotherapy, Week 33

• 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

Chemotherapy, Week 34

• 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

Supportive Medications, Week 34

• 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

Chemotherapy, Week 35

• 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

Chemotherapy, Week 36

• 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

Chemotherapy, Week 37

• 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

Supportive Medications, Week 37

• 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

Chemotherapy, Week 40

• 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

Supportive Medications, Week 40

• Mesna (Mesnex) by the following age-based criteria:
  • Age ≥ 3 years: 240 mg/m² at hour 0, 4, and 8 from the start of each Cyclophosphamide (Cytoxan) infusion on days 1
  • Age < 3 years: 8 mg/kg at hour 0, 4, and 8 from the start of each Cyclophosphamide (Cytoxan) infusion on days 1

References

1. COG ARST0531: Hawkins DS, Chi Y, Anderson JR, Tian, J, Arndt CAS, Bomgaars L, Donaldson SS, Hayes-Jordan A, Mascarenhas L, McCarville MB, McCune JS, McCowage G, Million L, Morris CD, Parham DM, Rodeberg DA, Rudzinski ER, Shnorhavorian M, Spunt SL, Skapek SX, Teot LA, Wolden S, Yock TI, Meyer WH. Addition of Vincristine and Irinotecan to Vincristine, Dactinomycin, and Cyclophosphamide Does Not Improve Outcome for Intermediate-Risk Rhabdomyosarcoma: A Report From the Children's Oncology Group. J Clin Oncol. 2018 Sep;36(27):2770-2777. Epub 2018 Aug 9. link to original article link to PMC article PubMed NCT01222715

COG ARST0531 VAC/VI Arm

Protocol, Weeks 1-15

Study	Years of enrollment	Evidence	Comparator	Comparative Efficacy
Hawkins et al. 2018 (COG ARST0531)	2006-2012	Phase 3 (E-switch-ic)	VAC	Did not meet primary endpoint of EFS

Chemotherapy, Week 1

• 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

Supportive Medications, Week 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

Chemotherapy, Week 2

• 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

Chemotherapy, Week 3

• 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

Chemotherapy, Week 4

• Radiation therapy begins
• 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 90 minutes once per day on days 1 through 5

Chemotherapy, Week 5

• Radiation therapy continues
• 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

Chemotherapy, Week 6

• Radiation therapy continues
• 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

Chemotherapy, Week 7

• Radiation therapy continues
• 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 90 minutes once per day on days 1 through 5

Chemotherapy, Week 8

• Radiation therapy continues
• 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

Chemotherapy, Week 9

• Radiation therapy final week
• 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

Chemotherapy, Week 10

• 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
• 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

Supportive Medications, Week 10

• 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

Chemotherapy, Week 11

• 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

Chemotherapy, Week 12

• 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

Chemotherapy, Week 13

• 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

Supportive Medications, Week 13

• 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

Protocol, Weeks 16-30

Chemotherapy, Week 16

• 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 90 minutes once per day on days 1 through 5

Chemotherapy, Week 17

• 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

Chemotherapy, Week 19

• 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 90 minutes once per day on days 1 through 5

Chemotherapy, Week 20

• 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

Chemotherapy, Week 22

• 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

Supportive Medications, Week 22

• 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

Chemotherapy, Week 23

• 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

Chemotherapy, Week 24

• 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

Chemotherapy, Week 25

• 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 90 minutes once per day on days 1 through 5

Chemotherapy, Week 26

• 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

Chemotherapy, Week 28

• 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

Supportive Medications, Week 28

• 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

Protocol, Weeks 31-43

Chemotherapy, Week 31

• 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 90 minutes once per day on days 1 through 5

Chemotherapy, Week 32

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

Chemotherapy, Week 33

• 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

Chemotherapy, Week 34

• 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

Supportive Medications, Week 34

• 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

Chemotherapy, Week 37

• 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 90 minutes once per day on days 1 through 5

Chemotherapy, Week 38

• 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

Chemotherapy, Week 40

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

References

1. COG ARST0531: Hawkins DS, Chi Y, Anderson JR, Tian J, Arndt CAS, Bomgaars L, Donaldson SS, Hayes-Jordan A, Mascarenhas L, McCarville MB, McCune JS, McCowage G, Million L, Morris CD, Parham DM, Rodeberg DA, Rudzinski ER, Shnorhavorian M, Spunt SL, Skapek SX, Teot LA, Wolden S, Yock TI, Meyer WH. Addition of Vincristine and Irinotecan to Vincristine, Dactinomycin, and Cyclophosphamide Does Not Improve Outcome for Intermediate-Risk Rhabdomyosarcoma: A Report From the Children's Oncology Group. J Clin Oncol. 2018 Sep;36(27):2770-2777. Epub 2018 Aug 9. link to original article link to PMC article PubMed NCT01222715

Low Risk

COG ARST1431 Protocol C (VAC/VA Only)

Protocol, 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

Supportive Medications

• Mesna (Mesnex) by the following BSA-based criteria:
  • 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
    • Mesna (Mesnex) can also be given PO at twice the IV dose

Protocol, 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

References

1. Vinorelbine and low dose cyclophosphamide maintenance therapy: Vinorelbine and low dose cyclophosphamide maintenance therapy: Bisogno G, De Salvo GL, Bergeron C, Gallego Melcons s, Merks JH, Kelsey A, Martelli H, Minard-Colin V, Orbach D, Glosli H, Chisholm J, Casanova M, Zanetti I, Devalck C, Ben-Arush M, Mudry P, Ferman S, Jenney M, Ferrari A. Vinorelbine and continuous low-dose cyclophosphamide as maintenance chemotherapy in patients with high-risk rhabdomyosarcoma (RMS 2005): a multicentre, open-label, randomised, phase 3 tial. Lancet Oncol. 2019 Nov;20(11):1566-1575. link to original article PubMed
2. COG ARST1431: NCT02567435

High Risk

COG ARST0431

Protocol, Weeks 1-6

Chemotherapy, 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

Chemotherapy, 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

Chemotherapy, 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

Chemotherapy, 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

Chemotherapy, 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

Protocol, Weeks 7-19

Chemotherapy, 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

Supportive Medications, Week 7

• 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

Chemotherapy, 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

Chemotherapy, 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
• 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

Supportive Medications, Week 9

• 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

Chemotherapy, 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

Supportive Medications, Week 11

• 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

Chemotherapy, 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

Chemotherapy, 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
• 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

Supportive Medications, Week 13

• 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

Chemotherapy, 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

Supportive Medications, Week 15

• 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

Chemotherapy, 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

Chemotherapy, 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
• 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

Supportive Medications, Week 17

• 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

Protocol, Weeks 20-34

Chemotherapy, 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

Chemotherapy, 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

Chemotherapy, 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

Chemotherapy, 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

Chemotherapy, 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

Chemotherapy, 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
• 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

Supportive Medications, Week 26

• 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

Chemotherapy, 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

Supportive Medications, Week 28

• 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

Chemotherapy, 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

Chemotherapy, 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
• 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

Supportive Medications, Week 30

• 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

Chemotherapy, 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

Supportive Medications, Week 32

• 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

Chemotherapy, 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

Protocol, Weeks 35-54

Chemotherapy, 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

Supportive Medications, Week 35

• 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

Chemotherapy, 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

Supportive Medications, Week 38

• 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

Chemotherapy, 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

Supportive Medications, Week 41

• 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

Chemotherapy, 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

Chemotherapy, 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

Chemotherapy, 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

Supportive Medications, Week 44

• 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

Chemotherapy, 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

Chemotherapy, 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

Chemotherapy, 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

Chemotherapy, 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

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