Difference between revisions of "Rhabdomyosarcoma"
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− | + | <span id="BackToTop"></span> | |
− | + | <div class="noprint" style="background-color:LightGray; position:fixed; bottom:2%; right:0.25%; padding-left:5px; padding-right:5px; margin: 15px; opacity:0.8; border-style: solid; border-color:DarkGray; border-width: 1px"> | |
− | + | [[#top|Back to Top]] | |
− | + | </div> | |
− | + | {{#lst:Editorial board transclusions|sarcoma}} | |
− | |- | + | {| class="wikitable" style="float:right; margin-right: 5px;" |
+ | |-|- | ||
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+ | Note: these are regimens tested in subtype-specific populations, please see the '''[[Soft_tissue_sarcoma|main soft tissue sarcoma page]]''' for other regimens. Pleomorphic rhabdomyosarcoma is typically treated the same as [[soft tissue sarcoma]]. | ||
+ | <br>'''Note: certain regimens are to be found on dedicated pages: | ||
+ | *'''[[Rhabdomyosarcoma, pediatric|Pediatric rhabdomyosarcoma]] | ||
+ | |||
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{{TOC limit|limit=3}} | {{TOC limit|limit=3}} | ||
− | = | + | =Guidelines= |
− | + | '''Given the rapid change in evidence in many areas of hematology/oncology, readers are encouraged to consider any guideline published 5+ years ago to be for historical purposes, only.''' | |
− | + | ==NCCN== | |
− | + | *''NCCN does not currently have guidelines at this granular level; please see [https://www.nccn.org/guidelines/guidelines-detail?category=1&id=1464 NCCN Guidelines - Soft Tissue Sarcoma].'' | |
− | + | =Adjuvant therapy= | |
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− | '' | ||
− | == | ||
− | * | ||
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==VA {{#subobject:a9710b|Regimen=1}}== | ==VA {{#subobject:a9710b|Regimen=1}}== | ||
− | |||
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VA: '''<u>V</u>'''incristine & '''<u>A</u>'''ctinomycin D | VA: '''<u>V</u>'''incristine & '''<u>A</u>'''ctinomycin D | ||
+ | <div class="toccolours" style="background-color:#eeeeee"> | ||
===Regimen {{#subobject:62e238|Variant=1}}=== | ===Regimen {{#subobject:62e238|Variant=1}}=== | ||
− | {| class="wikitable" style="width: 100%; text-align:center;" | + | {| class="wikitable sortable" style="width: 100%; text-align:center;" |
!style="width: 20%"|Study | !style="width: 20%"|Study | ||
− | !style="width: 20%"| | + | !style="width: 20%"|Dates of enrollment |
!style="width: 20%"|[[Levels_of_Evidence#Evidence|Evidence]] | !style="width: 20%"|[[Levels_of_Evidence#Evidence|Evidence]] | ||
!style="width: 20%"|Comparator | !style="width: 20%"|Comparator | ||
!style="width: 20%"|[[Levels_of_Evidence#Comparative_efficacy|Comparative Efficacy]] | !style="width: 20%"|[[Levels_of_Evidence#Comparative_efficacy|Comparative Efficacy]] | ||
|- | |- | ||
− | |[https:// | + | |[https://doi.org/10.1002/1097-0142(19930301)71:5%3C1904::AID-CNCR2820710530%3E3.0.CO;2-X Maurer et al. 1993 (IRS-II)] |
− | | | + | |1978-1984 |
− | | style="background-color:#1a9851" |Phase | + | | style="background-color:#1a9851" |Phase 3 (C) |
|[[#VAC|VAC]] | |[[#VAC|VAC]] | ||
− | | style="background-color:#ffffbf" |Did not meet primary endpoints of DFS/OS | + | | style="background-color:#ffffbf" |Did not meet co-primary endpoints of DFS/OS |
|- | |- | ||
− | |[https:// | + | |[https://doi.org/10.1200/JCO.1995.13.3.610 Crist et al. 1995 (IRS-III)] |
|1984-1991 | |1984-1991 | ||
− | | style="background-color:#1a9851" |Phase | + | | style="background-color:#1a9851" |Phase 3 (C) |
|[[#VAC|VAC]] | |[[#VAC|VAC]] | ||
| style="background-color:#ffffbf" |Did not meet primary endpoint of PFS | | style="background-color:#ffffbf" |Did not meet primary endpoint of PFS | ||
Line 62: | Line 47: | ||
|} | |} | ||
''Note: reported efficacy is for group I favorable-histology tumors.'' | ''Note: reported efficacy is for group I favorable-histology tumors.'' | ||
+ | <div class="toccolours" style="background-color:#cbd5e8"> | ||
+ | ====Preceding treatment==== | ||
+ | *[[Surgery#Surgical_resection|Surgery]] | ||
+ | </div> | ||
+ | <div class="toccolours" style="background-color:#b3e2cd"> | ||
====Chemotherapy==== | ====Chemotherapy==== | ||
− | *[[Vincristine (Oncovin)]] | + | *[[Vincristine (Oncovin)]] as follows: |
− | *[[Dactinomycin (Cosmegen)]] | + | **Cycle 1: 2 mg/m<sup>2</sup> (maximum dose of 2 mg) IV once per day on days 1, 8, 15, 22, 29, 36, 43, 50, 57, 64, 71, 78 (12 doses) |
− | + | *[[Dactinomycin (Cosmegen)]] 0.015 mg/kg (maximum dose of 0.5 mg) IV once per day on days 1 to 5 | |
+ | '''12-week cycle for 5 cycles''' | ||
+ | </div></div> | ||
===References=== | ===References=== | ||
− | # '''IRS-II:''' Maurer HM, Gehan EA, Beltangady M, Crist W, Dickman PS, Donaldson SS, Fryer C, Hammond D, Hays DM, Herrmann J, Heyn R, Jones PM, Lawrence W, Newton W, Ortega J, Ragab AH, Raney RB, Ruymann FB, Soule E, Tefft M, Webber B, Wiener E, Wharam M, Vietti TJ. The Intergroup Rhabdomyosarcoma Study-II. Cancer. 1993 Mar 1;71(5):1904-22. [https:// | + | # '''IRS-II:''' Maurer HM, Gehan EA, Beltangady M, Crist W, Dickman PS, Donaldson SS, Fryer C, Hammond D, Hays DM, Herrmann J, Heyn R, Jones PM, Lawrence W, Newton W, Ortega J, Ragab AH, Raney RB, Ruymann FB, Soule E, Tefft M, Webber B, Wiener E, Wharam M, Vietti TJ. The Intergroup Rhabdomyosarcoma Study-II. Cancer. 1993 Mar 1;71(5):1904-22. [https://doi.org/10.1002/1097-0142(19930301)71:5%3C1904::AID-CNCR2820710530%3E3.0.CO;2-X link to original article] '''dosing details in manuscript have been reviewed by our editors''' [https://pubmed.ncbi.nlm.nih.gov/8448756/ PubMed] |
− | # '''IRS-III:''' Crist W, Gehan EA, Ragab AH, Dickman PS, Donaldson SS, Fryer C, Hammond D, Hays DM, Herrmann J, Heyn R, Jones PM, Lawrence W, Newton W, Ortega J, Raney RB, Ruymann FB, Tefft M, Webber B, Wiener E, Wharam M, Vietti TJ, Maurer HM. The Third Intergroup Rhabdomyosarcoma Study. J Clin Oncol. 1995 Mar;13(3):610-30. [https:// | + | # '''IRS-III:''' Crist W, Gehan EA, Ragab AH, Dickman PS, Donaldson SS, Fryer C, Hammond D, Hays DM, Herrmann J, Heyn R, Jones PM, Lawrence W, Newton W, Ortega J, Raney RB, Ruymann FB, Tefft M, Webber B, Wiener E, Wharam M, Vietti TJ, Maurer HM. The Third Intergroup Rhabdomyosarcoma Study. J Clin Oncol. 1995 Mar;13(3):610-30. [https://doi.org/10.1200/JCO.1995.13.3.610 link to original article] [https://pubmed.ncbi.nlm.nih.gov/7884423/ PubMed] |
− | + | =All lines of therapy= | |
==VAC {{#subobject:4f2267|Regimen=1}}== | ==VAC {{#subobject:4f2267|Regimen=1}}== | ||
− | |||
− | |||
− | |||
− | |||
VAC: '''<u>V</u>'''incristine, '''<u>A</u>'''ctinomycin D, '''<u>C</u>'''yclophosphamide | VAC: '''<u>V</u>'''incristine, '''<u>A</u>'''ctinomycin D, '''<u>C</u>'''yclophosphamide | ||
+ | <div class="toccolours" style="background-color:#eeeeee"> | ||
===Regimen {{#subobject:060d90|Variant=1}}=== | ===Regimen {{#subobject:060d90|Variant=1}}=== | ||
− | {| class="wikitable" style="width: 100%; text-align:center;" | + | {| class="wikitable sortable" style="width: 100%; text-align:center;" |
!style="width: 20%"|Study | !style="width: 20%"|Study | ||
− | !style="width: 20%"| | + | !style="width: 20%"|Dates of enrollment |
!style="width: 20%"|[[Levels_of_Evidence#Evidence|Evidence]] | !style="width: 20%"|[[Levels_of_Evidence#Evidence|Evidence]] | ||
!style="width: 20%"|Comparator | !style="width: 20%"|Comparator | ||
!style="width: 20%"|[[Levels_of_Evidence#Comparative_efficacy|Comparative Efficacy]] | !style="width: 20%"|[[Levels_of_Evidence#Comparative_efficacy|Comparative Efficacy]] | ||
|- | |- | ||
− | |[https:// | + | |[https://doi.org/10.1002/1097-0142(197711)40:5%3C2015::aid-cncr2820400505%3E3.0.co;2-k Maurer et al. 1988 (IRS-I)] |
− | | | + | |1972-1978 |
− | | style="background-color:#1a9851" |Phase | + | | style="background-color:#1a9851" |Phase 3 (C) |
− | |VAC & RT | + | |[[#VAC_.26_RT_999|VAC & RT]] |
− | | style="background-color:#ffffbf" |Did not meet primary endpoints of DFS/OS | + | | style="background-color:#ffffbf" |Did not meet co-primary endpoints of DFS/OS |
|- | |- | ||
− | |[https:// | + | |[https://doi.org/10.1200/JCO.1995.13.3.610 Crist et al. 1995 (IRS-III)] |
|1984-1991 | |1984-1991 | ||
− | | style="background-color:#1a9851" |Phase | + | | style="background-color:#1a9851" |Phase 3 (E-RT-esc) |
|[[#VA|VA]] | |[[#VA|VA]] | ||
| style="background-color:#ffffbf" |Did not meet primary endpoint of PFS | | style="background-color:#ffffbf" |Did not meet primary endpoint of PFS | ||
|- | |- | ||
− | | rowspan="2" |[https:// | + | | rowspan="2" |[https://doi.org/10.1200/JCO.2001.19.12.3091 Crist et al. 2001 (IRS-IV)] |
− | |rowspan=2| | + | |rowspan=2|1991-1997 |
− | | rowspan="2" style="background-color:#1a9851" |Phase | + | | rowspan="2" style="background-color:#1a9851" |Phase 3 (E-switch-ic) |
|1. [[#VAI|VAI]] | |1. [[#VAI|VAI]] | ||
− | | style="background-color:#ffffbf" |Did not meet primary endpoints of FFS/OS | + | | style="background-color:#ffffbf" |Did not meet co-primary endpoints of FFS/OS |
|- | |- | ||
|2. [[#VIE|VIE]] | |2. [[#VIE|VIE]] | ||
− | | style="background-color:#ffffbf" |Did not meet primary endpoints of FFS/OS | + | | style="background-color:#ffffbf" |Did not meet co-primary endpoints of FFS/OS |
|- | |- | ||
|[https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2773476/ Arndt et al. 2009 (COG D9803)] | |[https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2773476/ Arndt et al. 2009 (COG D9803)] | ||
− | | | + | |1999-2005 |
− | | style="background-color:#1a9851" |Phase | + | | style="background-color:#1a9851" |Phase 3 (C) |
− | |VAC/VTC | + | |[[#VAC.2FVTC_999|VAC/VTC]] |
| style="background-color:#ffffbf" |Did not meet primary endpoint of FFS | | style="background-color:#ffffbf" |Did not meet primary endpoint of FFS | ||
|- | |- | ||
− | |[https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6145831/ Hawkins et al. 2018 (ARST0531)] | + | |[https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6145831/ Hawkins et al. 2018 (COG ARST0531)] |
− | | | + | |2006-2012 |
− | | style="background-color:#1a9851" |Phase | + | | style="background-color:#1a9851" |Phase 3 (C) |
− | |VAC/VI | + | |[[#VAC.2FVI_999|VAC/VI]] |
| style="background-color:#ffffbf" |Did not meet primary endpoint of EFS | | style="background-color:#ffffbf" |Did not meet primary endpoint of EFS | ||
|- | |- | ||
|} | |} | ||
− | + | ''Note: The first week of this protocol is week 0.'' | |
+ | <div class="toccolours" style="background-color:#b3e2cd"> | ||
====Chemotherapy==== | ====Chemotherapy==== | ||
− | *[[Vincristine (Oncovin)]] | + | *[[Vincristine (Oncovin)]] as follows: |
− | *[[Dactinomycin (Cosmegen)]] | + | **Weeks 0 to 11: 2 mg/m<sup>2</sup> (maximum dose of 2 mg) IV once on day 1 |
− | *[[Cyclophosphamide (Cytoxan)]] | + | *[[Dactinomycin (Cosmegen)]] as follows: |
− | + | **Weeks 0, 12, 24, 36, 48: 0.015 mg/kg IV once per day on days 1 to 5 | |
+ | *[[Cyclophosphamide (Cytoxan)]] as follows: | ||
+ | **Weeks 6 to 103: 2.5 mg/kg PO once per day on days 1 to 7 | ||
+ | '''104-week course''' | ||
+ | </div></div> | ||
===References=== | ===References=== | ||
− | # '''IRS-I:''' Maurer HM, Beltangady M, Gehan EA, Crist W, Hammond D, Hays DM, Heyn R, Lawrence W, Newton W, Ortega J, Ragab AH, Raney RB, Ruymann FB, Soule E, Tefft M, Webber B, Wharam M, Vietti TJ. The Intergroup Rhabdomyosarcoma Study-I: a final report. Cancer. 1988 Jan 15;61(2):209-20. [https:// | + | # '''IRS-I:''' Maurer HM, Moon T, Donaldson M, Fernandez C, Gehan EA, Hammond D, Hays DM, Lawrence W Jr, Newton W, Ragab A, Raney B, Soule EH, Sutow WW, Tefft M. The intergroup rhabdomyosarcoma study: a preliminary report. Cancer. 1977 Nov;40(5):2015-26. [https://doi.org/10.1002/1097-0142(197711)40:5%3C2015::aid-cncr2820400505%3E3.0.co;2-k link to original article] '''dosing details in manuscript have been reviewed by our editors''' [https://pubmed.ncbi.nlm.nih.gov/336175/ PubMed] |
− | # '''IRS-III:''' Crist W, Gehan EA, Ragab AH, Dickman PS, Donaldson SS, Fryer C, Hammond D, Hays DM, Herrmann J, Heyn R, Jones PM, Lawrence W, Newton W, Ortega J, Raney RB, Ruymann FB, Tefft M, Webber B, Wiener E, Wharam M, Vietti TJ, Maurer HM. The Third Intergroup Rhabdomyosarcoma Study. J Clin Oncol. 1995 Mar;13(3):610-30. [https:// | + | ##'''Update:''' Maurer HM, Beltangady M, Gehan EA, Crist W, Hammond D, Hays DM, Heyn R, Lawrence W, Newton W, Ortega J, Ragab AH, Raney RB, Ruymann FB, Soule E, Tefft M, Webber B, Wharam M, Vietti TJ. The Intergroup Rhabdomyosarcoma Study-I: a final report. Cancer. 1988 Jan 15;61(2):209-20. [https://doi.org/10.1002/1097-0142(19880115)61:2%3C209::AID-CNCR2820610202%3E3.0.CO;2-L link to original article] [https://pubmed.ncbi.nlm.nih.gov/3275486/ PubMed] |
− | # '''IRS-IV:''' Crist WM, Anderson JR, Meza JL, Fryer C, Raney RB, Ruymann FB, Breneman J, Qualman SJ, Wiener E, Wharam M, Lobe T, Webber B, Maurer HM, Donaldson SS. Intergroup Rhabdomyosarcoma Study-IV: results for patients with nonmetastatic disease. J Clin Oncol. 2001 Jun 15;19(12):3091-102. [https:// | + | # '''IRS-III:''' Crist W, Gehan EA, Ragab AH, Dickman PS, Donaldson SS, Fryer C, Hammond D, Hays DM, Herrmann J, Heyn R, Jones PM, Lawrence W, Newton W, Ortega J, Raney RB, Ruymann FB, Tefft M, Webber B, Wiener E, Wharam M, Vietti TJ, Maurer HM. The Third Intergroup Rhabdomyosarcoma Study. J Clin Oncol. 1995 Mar;13(3):610-30. [https://doi.org/10.1200/JCO.1995.13.3.610 link to original article] [https://pubmed.ncbi.nlm.nih.gov/7884423/ PubMed] |
− | # '''COG D9803:''' Arndt CA, Stoner JA, Hawkins DS, Rodeberg DA, Hayes-Jordan AA, Paidas CN, Parham DM, Teot LA, Wharam MD, Breneman JC, Donaldson SS, Anderson JR, Meyer WH. Vincristine, actinomycin, and cyclophosphamide compared with vincristine, actinomycin, and cyclophosphamide alternating with vincristine, topotecan, and cyclophosphamide for intermediate-risk rhabdomyosarcoma: Children's Oncology Group study D9803. J Clin Oncol. 2009 Nov 1;27(31):5182-8. Epub 2009 Sep 21. [https:// | + | # '''IRS-IV:''' Crist WM, Anderson JR, Meza JL, Fryer C, Raney RB, Ruymann FB, Breneman J, Qualman SJ, Wiener E, Wharam M, Lobe T, Webber B, Maurer HM, Donaldson SS. Intergroup Rhabdomyosarcoma Study-IV: results for patients with nonmetastatic disease. J Clin Oncol. 2001 Jun 15;19(12):3091-102. [https://doi.org/10.1200/JCO.2001.19.12.3091 link to original article] [https://pubmed.ncbi.nlm.nih.gov/11408506/ PubMed] |
− | # '''ARST0531:''' Hawkins DS, Chi YY, 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 | + | # '''COG D9803:''' Arndt CA, Stoner JA, Hawkins DS, Rodeberg DA, Hayes-Jordan AA, Paidas CN, Parham DM, Teot LA, Wharam MD, Breneman JC, Donaldson SS, Anderson JR, Meyer WH. Vincristine, actinomycin, and cyclophosphamide compared with vincristine, actinomycin, and cyclophosphamide alternating with vincristine, topotecan, and cyclophosphamide for intermediate-risk rhabdomyosarcoma: Children's Oncology Group study D9803. J Clin Oncol. 2009 Nov 1;27(31):5182-8. Epub 2009 Sep 21. [https://doi.org/10.1200/JCO.2009.22.3768 link to original article] [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2773476/ link to PMC article] [https://pubmed.ncbi.nlm.nih.gov/19770373/ PubMed] [https://clinicaltrials.gov/study/NCT00003958 NCT00003958] |
+ | # '''COG ARST0531:''' Hawkins DS, Chi YY, 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; Children's Oncology Group. 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 20;36(27):2770-2777. Epub 2018 Aug 9. [https://doi.org/10.1200/JCO.2018.77.9694 link to original article] [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6145831/ link to PMC article] [https://pubmed.ncbi.nlm.nih.gov/30091945/ PubMed] [https://clinicaltrials.gov/study/NCT00354835 NCT00354835] | ||
==VAI {{#subobject:9ab538|Regimen=1}}== | ==VAI {{#subobject:9ab538|Regimen=1}}== | ||
− | |||
− | |||
− | |||
− | |||
VAI: '''<u>V</u>'''incristine, '''<u>A</u>'''ctinomycin-D (Dactinomycin), '''<u>I</u>'''fosfamide | VAI: '''<u>V</u>'''incristine, '''<u>A</u>'''ctinomycin-D (Dactinomycin), '''<u>I</u>'''fosfamide | ||
<br>IVA: '''<u>I</u>'''fosfamide, '''<u>V</u>'''incristine, '''<u>A</u>'''ctinomycin-D (Dactinomycin) | <br>IVA: '''<u>I</u>'''fosfamide, '''<u>V</u>'''incristine, '''<u>A</u>'''ctinomycin-D (Dactinomycin) | ||
+ | <div class="toccolours" style="background-color:#eeeeee"> | ||
===Regimen {{#subobject:49f6c6|Variant=1}}=== | ===Regimen {{#subobject:49f6c6|Variant=1}}=== | ||
− | {| class="wikitable" style="width: 100%; text-align:center;" | + | {| class="wikitable sortable" style="width: 100%; text-align:center;" |
− | !style="width: | + | !style="width: 20%"|Study |
− | !style="width: | + | !style="width: 20%"|Dates of enrollment |
− | !style="width: | + | !style="width: 20%"|[[Levels_of_Evidence#Evidence|Evidence]] |
− | !style="width: | + | !style="width: 20%"|Comparator |
+ | !style="width: 20%"|[[Levels_of_Evidence#Comparative_efficacy|Comparative Efficacy]] | ||
|- | |- | ||
− | | rowspan="2" |[https:// | + | | rowspan="2" |[https://doi.org/10.1200/JCO.2001.19.12.3091 Crist et al. 2001 (IRS-IV)] |
− | | rowspan="2" style="background-color:#1a9851" |Phase | + | |rowspan=2|1991-1997 |
+ | | rowspan="2" style="background-color:#1a9851" |Phase 3 (E-switch-ic) | ||
|1. [[#VAC|VAC]] | |1. [[#VAC|VAC]] | ||
− | | style="background-color:#ffffbf" |Did not meet primary endpoints of FFS/OS | + | | style="background-color:#ffffbf" |Did not meet co-primary endpoints of FFS/OS |
|- | |- | ||
|2. [[#VIE|VIE]] | |2. [[#VIE|VIE]] | ||
− | | style="background-color:#ffffbf" |Did not meet primary endpoints of FFS/OS | + | | style="background-color:#ffffbf" |Did not meet co-primary endpoints of FFS/OS |
|- | |- | ||
− | |[https:// | + | |[https://doi.org/10.1200/JCO.2011.40.3287 Oberlin et al. 2012 (SIOP MMT95)] |
− | | style="background-color:#1a9851" |Phase | + | |1995-2003 |
− | |IVA/CEV/IVE | + | | style="background-color:#1a9851" |Phase 3 (C) |
+ | |[[#IVA.2FCEV.2FIVE_999|IVA/CEV/IVE]] | ||
| style="background-color:#ffffbf" |Did not meet primary endpoint of OS | | style="background-color:#ffffbf" |Did not meet primary endpoint of OS | ||
|- | |- | ||
− | |[https:// | + | |[https://doi.org/10.1016/S1470-2045(18)30337-1 Bisogno et al. 2018 (EpSSG RMS 2005)] |
− | | style="background-color:#1a9851" |Phase | + | |2006-2016 |
− | |IVA-D, then IVA | + | | style="background-color:#1a9851" |Phase 3 (C) |
+ | |[[#IVA-D_999|IVA-D]], then [[#VAI|IVA]] | ||
| style="background-color:#ffffbf" |Did not meet primary endpoint of EFS36 | | style="background-color:#ffffbf" |Did not meet primary endpoint of EFS36 | ||
|- | |- | ||
|} | |} | ||
− | + | <div class="toccolours" style="background-color:#b3e2cd"> | |
====Chemotherapy==== | ====Chemotherapy==== | ||
− | *[[Vincristine (Oncovin)]] | + | *[[Vincristine (Oncovin)]] 1.5 mg/m<sup>2</sup> (maximum dose of 2 mg) IV once per day on days 1, 8, 15 |
− | *[[Dactinomycin (Cosmegen)]] | + | *[[Dactinomycin (Cosmegen)]] 0.015 mg/kg IV once per day on days 1 to 5 |
− | *[[Ifosfamide (Ifex)]] | + | *[[Ifosfamide (Ifex)]] 1800 mg/m<sup>2</sup> IV once per day on days 1 to 5 |
+ | ====Supportive therapy==== | ||
+ | *[[Mesna (Mesnex)]] | ||
+ | '''21-day cycle for 3 cycles''' | ||
+ | </div> | ||
+ | <div class="toccolours" style="background-color:#cbd5e8"> | ||
+ | ====Subsequent treatment==== | ||
+ | *[[#Irinotecan_.26_Vincristine_.28VI.29_.26_RT_888|VI & RT]] consolidation | ||
+ | </div></div> | ||
===References=== | ===References=== | ||
− | # '''IRS-IV:''' Crist WM, Anderson JR, Meza JL, Fryer C, Raney RB, Ruymann FB, Breneman J, Qualman SJ, Wiener E, Wharam M, Lobe T, Webber B, Maurer HM, Donaldson SS. Intergroup Rhabdomyosarcoma Study-IV: results for patients with nonmetastatic disease. J Clin Oncol. 2001 Jun 15;19(12):3091-102. [https:// | + | # '''IRS-IV:''' Crist WM, Anderson JR, Meza JL, Fryer C, Raney RB, Ruymann FB, Breneman J, Qualman SJ, Wiener E, Wharam M, Lobe T, Webber B, Maurer HM, Donaldson SS. Intergroup Rhabdomyosarcoma Study-IV: results for patients with nonmetastatic disease. J Clin Oncol. 2001 Jun 15;19(12):3091-102. [https://doi.org/10.1200/JCO.2001.19.12.3091 link to original article] '''dosing details in manuscript have been reviewed by our editors''' [https://pubmed.ncbi.nlm.nih.gov/11408506/ PubMed] |
− | # '''SIOP MMT95:''' Oberlin O, Rey A, Sanchez de Toledo J, Martelli H, Jenney ME, Scopinaro M, Bergeron C, Merks JH, Bouvet N, Ellershaw C, Kelsey A, Spooner D, Stevens MC. Randomized comparison of intensified six-drug versus standard three-drug chemotherapy for high-risk nonmetastatic rhabdomyosarcoma and other chemotherapy-sensitive childhood soft tissue sarcomas: long-term results from the International Society of Pediatric Oncology MMT95 study. J Clin Oncol. 2012 Jul 10;30(20):2457-65. Epub 2012 Jun 4. [https:// | + | # '''SIOP MMT95:''' Oberlin O, Rey A, Sanchez de Toledo J, Martelli H, Jenney ME, Scopinaro M, Bergeron C, Merks JH, Bouvet N, Ellershaw C, Kelsey A, Spooner D, Stevens MC. Randomized comparison of intensified six-drug versus standard three-drug chemotherapy for high-risk nonmetastatic rhabdomyosarcoma and other chemotherapy-sensitive childhood soft tissue sarcomas: long-term results from the International Society of Pediatric Oncology MMT95 study. J Clin Oncol. 2012 Jul 10;30(20):2457-65. Epub 2012 Jun 4. [https://doi.org/10.1200/JCO.2011.40.3287 link to original article] [https://pubmed.ncbi.nlm.nih.gov/22665534/ PubMed] [https://clinicaltrials.gov/study/NCT00002898 NCT00002898] |
− | # '''EpSSG RMS 2005:''' Bisogno G, Jenney M, Bergeron C, Gallego Melcón S, Ferrari A, Oberlin O, Carli M, Stevens M, Kelsey A, De Paoli A, Gaze MN, Martelli H, Devalck C, Merks JH, Ben-Arush M, Glosli H, Chisholm J, Orbach D, Minard-Colin V, De Salvo GL; European paediatric Soft tissue sarcoma Study Group. Addition of dose-intensified doxorubicin to standard chemotherapy for rhabdomyosarcoma (EpSSG RMS 2005): a multicentre, open-label, randomised controlled, phase 3 trial. Lancet Oncol. 2018 Aug;19(8):1061-1071. Epub 2018 Jun 22. [https:// | + | # '''EpSSG RMS 2005:''' Bisogno G, Jenney M, Bergeron C, Gallego Melcón S, Ferrari A, Oberlin O, Carli M, Stevens M, Kelsey A, De Paoli A, Gaze MN, Martelli H, Devalck C, Merks JH, Ben-Arush M, Glosli H, Chisholm J, Orbach D, Minard-Colin V, De Salvo GL; European paediatric Soft tissue sarcoma Study Group. Addition of dose-intensified doxorubicin to standard chemotherapy for rhabdomyosarcoma (EpSSG RMS 2005): a multicentre, open-label, randomised controlled, phase 3 trial. Lancet Oncol. 2018 Aug;19(8):1061-1071. Epub 2018 Jun 22. [https://doi.org/10.1016/S1470-2045(18)30337-1 link to original article] [https://pubmed.ncbi.nlm.nih.gov/29941280/ PubMed] [https://clinicaltrials.gov/study/NCT00339118 NCT00339118] |
− | + | ## '''Update:''' Bisogno G, De Salvo GL, Bergeron C, Gallego Melcón 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; European paediatric Soft tissue sarcoma Study Group. Vinorelbine and continuous low-dose cyclophosphamide as maintenance chemotherapy in patients with high-risk rhabdomyosarcoma (RMS 2005): a multicentre, open-label, randomised, phase 3 trial. Lancet Oncol. 2019 Nov;20(11):1566-1575. Epub 2019 Sep 24. [https://doi.org/10.1016/s1470-2045(19)30617-5 link to original article] [https://pubmed.ncbi.nlm.nih.gov/31562043/ PubMed] | |
− | + | ##'''Update:''' Bisogno G, Minard-Colin V, Zanetti I, Ferrari A, Gallego S, Dávila Fajardo R, Mandeville H, Kelsey A, Alaggio R, Orbach D, Terwisscha van Scheltinga S, Guillén Burrieza G, Ben-Arush M, Glosli H, Mudry P, Ferman S, Devalck C, Defachelles AS, Merks JHM, Jenney M. Nonmetastatic Rhabdomyosarcoma in Children and Adolescents: Overall Results of the European Pediatric Soft Tissue Sarcoma Study Group RMS2005 Study. J Clin Oncol. 2023 May 1;41(13):2342-2349. Epub 2023 Feb 27. [https://doi.org/10.1200/jco.22.02093 link to original article] [https://pubmed.ncbi.nlm.nih.gov/36848614/ PubMed] | |
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==VIE {{#subobject:1b4037|Regimen=1}}== | ==VIE {{#subobject:1b4037|Regimen=1}}== | ||
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VIE: '''<u>V</u>'''incristine, '''<u>I</u>'''fosfamide, '''<u>E</u>'''toposide | VIE: '''<u>V</u>'''incristine, '''<u>I</u>'''fosfamide, '''<u>E</u>'''toposide | ||
+ | <div class="toccolours" style="background-color:#eeeeee"> | ||
===Regimen {{#subobject:f0d233|Variant=1}}=== | ===Regimen {{#subobject:f0d233|Variant=1}}=== | ||
− | {| class="wikitable" style="width: 100%; text-align:center;" | + | {| class="wikitable sortable" style="width: 100%; text-align:center;" |
− | !style="width: | + | !style="width: 20%"|Study |
− | !style="width: | + | !style="width: 20%"|Dates of enrollment |
− | !style="width: | + | !style="width: 20%"|[[Levels_of_Evidence#Evidence|Evidence]] |
− | !style="width: | + | !style="width: 20%"|Comparator |
+ | !style="width: 20%"|[[Levels_of_Evidence#Comparative_efficacy|Comparative Efficacy]] | ||
|- | |- | ||
− | | rowspan="2" |[https:// | + | | rowspan="2" |[https://doi.org/10.1200/JCO.2001.19.12.3091 Crist et al. 2001 (IRS-IV)] |
− | | rowspan="2" style="background-color:#1a9851" |Phase | + | |rowspan=2|1991-1997 |
+ | | rowspan="2" style="background-color:#1a9851" |Phase 3 (E-switch-ic) | ||
|1. [[#VAC|VAC]] | |1. [[#VAC|VAC]] | ||
− | | style="background-color:#ffffbf" |Did not meet primary endpoints of FFS/OS | + | | style="background-color:#ffffbf" |Did not meet co-primary endpoints of FFS/OS |
|- | |- | ||
|2. [[#VAI|VAI]] | |2. [[#VAI|VAI]] | ||
− | | style="background-color:#ffffbf" |Did not meet primary endpoints of FFS/OS | + | | style="background-color:#ffffbf" |Did not meet co-primary endpoints of FFS/OS |
|- | |- | ||
|} | |} | ||
− | + | <div class="toccolours" style="background-color:#b3e2cd"> | |
====Chemotherapy==== | ====Chemotherapy==== | ||
− | *[[Vincristine (Oncovin)]] | + | *[[Vincristine (Oncovin)]] 1.5 mg/m<sup>2</sup> (maximum dose of 2 mg) IV once per day on days 1, 8, 15 |
− | *[[Ifosfamide (Ifex)]] | + | *[[Ifosfamide (Ifex)]] 1800 mg/m<sup>2</sup> IV once per day on days 1 to 5 |
− | *[[Etoposide (Vepesid)]] | + | *[[Etoposide (Vepesid)]] 100 mg/m<sup>2</sup> IV once per day on days 1 to 5 |
− | + | ====Supportive therapy==== | |
+ | *[[Mesna (Mesnex)]] (dose/schedule not specified) given with ifosfamide | ||
+ | '''21-day cycle for 3 cycles''' | ||
+ | </div> | ||
+ | <div class="toccolours" style="background-color:#cbd5e8"> | ||
+ | ====Subsequent treatment==== | ||
+ | *[[#Irinotecan_.26_Vincristine_.28VI.29_.26_RT_888|VI & RT]] consolidation, then [[#VIE|VIE]] consolidation x 1, then [[#VIE|VIE]] continuation | ||
+ | </div></div> | ||
===References=== | ===References=== | ||
− | # '''IRS-IV:''' Crist WM, Anderson JR, Meza JL, Fryer C, Raney RB, Ruymann FB, Breneman J, Qualman SJ, Wiener E, Wharam M, Lobe T, Webber B, Maurer HM, Donaldson SS. Intergroup Rhabdomyosarcoma Study-IV: results for patients with nonmetastatic disease. J Clin Oncol. 2001 Jun 15;19(12):3091-102. [https:// | + | # '''IRS-IV:''' Crist WM, Anderson JR, Meza JL, Fryer C, Raney RB, Ruymann FB, Breneman J, Qualman SJ, Wiener E, Wharam M, Lobe T, Webber B, Maurer HM, Donaldson SS. Intergroup Rhabdomyosarcoma Study-IV: results for patients with nonmetastatic disease. J Clin Oncol. 2001 Jun 15;19(12):3091-102. [https://doi.org/10.1200/JCO.2001.19.12.3091 link to original article] '''dosing details in manuscript have been reviewed by our editors''' [https://pubmed.ncbi.nlm.nih.gov/11408506/ PubMed] |
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[[Category:Rhabdomyosarcoma regimens]] | [[Category:Rhabdomyosarcoma regimens]] | ||
[[Category:Disease-specific pages]] | [[Category:Disease-specific pages]] | ||
[[Category:Soft tissue sarcomas]] | [[Category:Soft tissue sarcomas]] | ||
− |
Latest revision as of 12:20, 15 July 2024
Section editor | |
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Elizabeth J. Davis, MD Vanderbilt University Nashville, TN, USA |
Note: these are regimens tested in subtype-specific populations, please see the main soft tissue sarcoma page for other regimens. Pleomorphic rhabdomyosarcoma is typically treated the same as soft tissue sarcoma.
Note: certain regimens are to be found on dedicated pages:
4 regimens on this page
4 variants on this page
|
Guidelines
Given the rapid change in evidence in many areas of hematology/oncology, readers are encouraged to consider any guideline published 5+ years ago to be for historical purposes, only.
NCCN
- NCCN does not currently have guidelines at this granular level; please see NCCN Guidelines - Soft Tissue Sarcoma.
Adjuvant therapy
VA
VA: Vincristine & Actinomycin D
Regimen
Study | Dates of enrollment | Evidence | Comparator | Comparative Efficacy |
---|---|---|---|---|
Maurer et al. 1993 (IRS-II) | 1978-1984 | Phase 3 (C) | VAC | Did not meet co-primary endpoints of DFS/OS |
Crist et al. 1995 (IRS-III) | 1984-1991 | Phase 3 (C) | VAC | Did not meet primary endpoint of PFS |
Note: reported efficacy is for group I favorable-histology tumors.
Preceding treatment
Chemotherapy
- Vincristine (Oncovin) as follows:
- Cycle 1: 2 mg/m2 (maximum dose of 2 mg) IV once per day on days 1, 8, 15, 22, 29, 36, 43, 50, 57, 64, 71, 78 (12 doses)
- Dactinomycin (Cosmegen) 0.015 mg/kg (maximum dose of 0.5 mg) IV once per day on days 1 to 5
12-week cycle for 5 cycles
References
- IRS-II: Maurer HM, Gehan EA, Beltangady M, Crist W, Dickman PS, Donaldson SS, Fryer C, Hammond D, Hays DM, Herrmann J, Heyn R, Jones PM, Lawrence W, Newton W, Ortega J, Ragab AH, Raney RB, Ruymann FB, Soule E, Tefft M, Webber B, Wiener E, Wharam M, Vietti TJ. The Intergroup Rhabdomyosarcoma Study-II. Cancer. 1993 Mar 1;71(5):1904-22. link to original article dosing details in manuscript have been reviewed by our editors PubMed
- IRS-III: Crist W, Gehan EA, Ragab AH, Dickman PS, Donaldson SS, Fryer C, Hammond D, Hays DM, Herrmann J, Heyn R, Jones PM, Lawrence W, Newton W, Ortega J, Raney RB, Ruymann FB, Tefft M, Webber B, Wiener E, Wharam M, Vietti TJ, Maurer HM. The Third Intergroup Rhabdomyosarcoma Study. J Clin Oncol. 1995 Mar;13(3):610-30. link to original article PubMed
All lines of therapy
VAC
VAC: Vincristine, Actinomycin D, Cyclophosphamide
Regimen
Study | Dates of enrollment | Evidence | Comparator | Comparative Efficacy |
---|---|---|---|---|
Maurer et al. 1988 (IRS-I) | 1972-1978 | Phase 3 (C) | VAC & RT | Did not meet co-primary endpoints of DFS/OS |
Crist et al. 1995 (IRS-III) | 1984-1991 | Phase 3 (E-RT-esc) | VA | Did not meet primary endpoint of PFS |
Crist et al. 2001 (IRS-IV) | 1991-1997 | Phase 3 (E-switch-ic) | 1. VAI | Did not meet co-primary endpoints of FFS/OS |
2. VIE | Did not meet co-primary endpoints of FFS/OS | |||
Arndt et al. 2009 (COG D9803) | 1999-2005 | Phase 3 (C) | VAC/VTC | Did not meet primary endpoint of FFS |
Hawkins et al. 2018 (COG ARST0531) | 2006-2012 | Phase 3 (C) | VAC/VI | Did not meet primary endpoint of EFS |
Note: The first week of this protocol is week 0.
Chemotherapy
- Vincristine (Oncovin) as follows:
- Weeks 0 to 11: 2 mg/m2 (maximum dose of 2 mg) IV once on day 1
- Dactinomycin (Cosmegen) as follows:
- Weeks 0, 12, 24, 36, 48: 0.015 mg/kg IV once per day on days 1 to 5
- Cyclophosphamide (Cytoxan) as follows:
- Weeks 6 to 103: 2.5 mg/kg PO once per day on days 1 to 7
104-week course
References
- IRS-I: Maurer HM, Moon T, Donaldson M, Fernandez C, Gehan EA, Hammond D, Hays DM, Lawrence W Jr, Newton W, Ragab A, Raney B, Soule EH, Sutow WW, Tefft M. The intergroup rhabdomyosarcoma study: a preliminary report. Cancer. 1977 Nov;40(5):2015-26. link to original article dosing details in manuscript have been reviewed by our editors PubMed
- Update: Maurer HM, Beltangady M, Gehan EA, Crist W, Hammond D, Hays DM, Heyn R, Lawrence W, Newton W, Ortega J, Ragab AH, Raney RB, Ruymann FB, Soule E, Tefft M, Webber B, Wharam M, Vietti TJ. The Intergroup Rhabdomyosarcoma Study-I: a final report. Cancer. 1988 Jan 15;61(2):209-20. link to original article PubMed
- IRS-III: Crist W, Gehan EA, Ragab AH, Dickman PS, Donaldson SS, Fryer C, Hammond D, Hays DM, Herrmann J, Heyn R, Jones PM, Lawrence W, Newton W, Ortega J, Raney RB, Ruymann FB, Tefft M, Webber B, Wiener E, Wharam M, Vietti TJ, Maurer HM. The Third Intergroup Rhabdomyosarcoma Study. J Clin Oncol. 1995 Mar;13(3):610-30. link to original article PubMed
- IRS-IV: Crist WM, Anderson JR, Meza JL, Fryer C, Raney RB, Ruymann FB, Breneman J, Qualman SJ, Wiener E, Wharam M, Lobe T, Webber B, Maurer HM, Donaldson SS. Intergroup Rhabdomyosarcoma Study-IV: results for patients with nonmetastatic disease. J Clin Oncol. 2001 Jun 15;19(12):3091-102. link to original article PubMed
- COG D9803: Arndt CA, Stoner JA, Hawkins DS, Rodeberg DA, Hayes-Jordan AA, Paidas CN, Parham DM, Teot LA, Wharam MD, Breneman JC, Donaldson SS, Anderson JR, Meyer WH. Vincristine, actinomycin, and cyclophosphamide compared with vincristine, actinomycin, and cyclophosphamide alternating with vincristine, topotecan, and cyclophosphamide for intermediate-risk rhabdomyosarcoma: Children's Oncology Group study D9803. J Clin Oncol. 2009 Nov 1;27(31):5182-8. Epub 2009 Sep 21. link to original article link to PMC article PubMed NCT00003958
- COG ARST0531: Hawkins DS, Chi YY, 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; Children's Oncology Group. 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 20;36(27):2770-2777. Epub 2018 Aug 9. link to original article link to PMC article PubMed NCT00354835
VAI
VAI: Vincristine, Actinomycin-D (Dactinomycin), Ifosfamide
IVA: Ifosfamide, Vincristine, Actinomycin-D (Dactinomycin)
Regimen
Study | Dates of enrollment | Evidence | Comparator | Comparative Efficacy |
---|---|---|---|---|
Crist et al. 2001 (IRS-IV) | 1991-1997 | Phase 3 (E-switch-ic) | 1. VAC | Did not meet co-primary endpoints of FFS/OS |
2. VIE | Did not meet co-primary endpoints of FFS/OS | |||
Oberlin et al. 2012 (SIOP MMT95) | 1995-2003 | Phase 3 (C) | IVA/CEV/IVE | Did not meet primary endpoint of OS |
Bisogno et al. 2018 (EpSSG RMS 2005) | 2006-2016 | Phase 3 (C) | IVA-D, then IVA | Did not meet primary endpoint of EFS36 |
Chemotherapy
- Vincristine (Oncovin) 1.5 mg/m2 (maximum dose of 2 mg) IV once per day on days 1, 8, 15
- Dactinomycin (Cosmegen) 0.015 mg/kg IV once per day on days 1 to 5
- Ifosfamide (Ifex) 1800 mg/m2 IV once per day on days 1 to 5
Supportive therapy
21-day cycle for 3 cycles
Subsequent treatment
- VI & RT consolidation
References
- IRS-IV: Crist WM, Anderson JR, Meza JL, Fryer C, Raney RB, Ruymann FB, Breneman J, Qualman SJ, Wiener E, Wharam M, Lobe T, Webber B, Maurer HM, Donaldson SS. Intergroup Rhabdomyosarcoma Study-IV: results for patients with nonmetastatic disease. J Clin Oncol. 2001 Jun 15;19(12):3091-102. link to original article dosing details in manuscript have been reviewed by our editors PubMed
- SIOP MMT95: Oberlin O, Rey A, Sanchez de Toledo J, Martelli H, Jenney ME, Scopinaro M, Bergeron C, Merks JH, Bouvet N, Ellershaw C, Kelsey A, Spooner D, Stevens MC. Randomized comparison of intensified six-drug versus standard three-drug chemotherapy for high-risk nonmetastatic rhabdomyosarcoma and other chemotherapy-sensitive childhood soft tissue sarcomas: long-term results from the International Society of Pediatric Oncology MMT95 study. J Clin Oncol. 2012 Jul 10;30(20):2457-65. Epub 2012 Jun 4. link to original article PubMed NCT00002898
- EpSSG RMS 2005: Bisogno G, Jenney M, Bergeron C, Gallego Melcón S, Ferrari A, Oberlin O, Carli M, Stevens M, Kelsey A, De Paoli A, Gaze MN, Martelli H, Devalck C, Merks JH, Ben-Arush M, Glosli H, Chisholm J, Orbach D, Minard-Colin V, De Salvo GL; European paediatric Soft tissue sarcoma Study Group. Addition of dose-intensified doxorubicin to standard chemotherapy for rhabdomyosarcoma (EpSSG RMS 2005): a multicentre, open-label, randomised controlled, phase 3 trial. Lancet Oncol. 2018 Aug;19(8):1061-1071. Epub 2018 Jun 22. link to original article PubMed NCT00339118
- Update: Bisogno G, De Salvo GL, Bergeron C, Gallego Melcón 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; European paediatric Soft tissue sarcoma Study Group. Vinorelbine and continuous low-dose cyclophosphamide as maintenance chemotherapy in patients with high-risk rhabdomyosarcoma (RMS 2005): a multicentre, open-label, randomised, phase 3 trial. Lancet Oncol. 2019 Nov;20(11):1566-1575. Epub 2019 Sep 24. link to original article PubMed
- Update: Bisogno G, Minard-Colin V, Zanetti I, Ferrari A, Gallego S, Dávila Fajardo R, Mandeville H, Kelsey A, Alaggio R, Orbach D, Terwisscha van Scheltinga S, Guillén Burrieza G, Ben-Arush M, Glosli H, Mudry P, Ferman S, Devalck C, Defachelles AS, Merks JHM, Jenney M. Nonmetastatic Rhabdomyosarcoma in Children and Adolescents: Overall Results of the European Pediatric Soft Tissue Sarcoma Study Group RMS2005 Study. J Clin Oncol. 2023 May 1;41(13):2342-2349. Epub 2023 Feb 27. link to original article PubMed
VIE
VIE: Vincristine, Ifosfamide, Etoposide
Regimen
Study | Dates of enrollment | Evidence | Comparator | Comparative Efficacy |
---|---|---|---|---|
Crist et al. 2001 (IRS-IV) | 1991-1997 | Phase 3 (E-switch-ic) | 1. VAC | Did not meet co-primary endpoints of FFS/OS |
2. VAI | Did not meet co-primary endpoints of FFS/OS |
Chemotherapy
- Vincristine (Oncovin) 1.5 mg/m2 (maximum dose of 2 mg) IV once per day on days 1, 8, 15
- Ifosfamide (Ifex) 1800 mg/m2 IV once per day on days 1 to 5
- Etoposide (Vepesid) 100 mg/m2 IV once per day on days 1 to 5
Supportive therapy
- Mesna (Mesnex) (dose/schedule not specified) given with ifosfamide
21-day cycle for 3 cycles
References
- IRS-IV: Crist WM, Anderson JR, Meza JL, Fryer C, Raney RB, Ruymann FB, Breneman J, Qualman SJ, Wiener E, Wharam M, Lobe T, Webber B, Maurer HM, Donaldson SS. Intergroup Rhabdomyosarcoma Study-IV: results for patients with nonmetastatic disease. J Clin Oncol. 2001 Jun 15;19(12):3091-102. link to original article dosing details in manuscript have been reviewed by our editors PubMed