Difference between revisions of "Staging page"

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[[#top|Back to Top]]
 
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{{#lst:Section editor transclusions|peds-sarcoma}}
 
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''Are you looking for a regimen, but can't find it here? It is possible that we've moved it to the [[Rhabdomyosarcoma_-_historical|historical regimens page]]. If you still can't find it, please let us know so we can add it!''
 
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{| class="wikitable" style="float:right; margin-right: 5px;"
 
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|<div style="background-color: #fee0d1; border: 1px solid #808000; padding: 5px; {{border-radius|16px}}" align="right"><font size="4"><b>{{#ask: [[-Has subobject::{{FULLPAGENAME}}]]  |?Regimen |limit=10000|format=sum}} [[Tutorial#Regimens|regimens]] on this page</b></font></div>
 
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<div style="background-color: #deebf6; border: 1px solid #808000; padding: 5px; {{border-radius|16px}}"><font size="4"><b>{{#ask: [[-Has subobject::{{FULLPAGENAME}}]]  |?Variant |limit=10000|format=sum}} [[Tutorial#Variants|variants]] on this page</b></font></div>
 
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|}
 
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{{TOC limit|limit=4}}
 
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=Intermediate Risk=
 
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==COG ARST1431 Protocol A (VAC/VI Only)==
 
−
<div class="toccolours" style="background-color:#eeeeee">
 
−
===Protocol, Cycles 1-4 (Weeks 1 through 12)===
 
−
====Chemotherapy====
 
−
*[[Vincristine (Oncovin)]] by the following BSA-based criteria:
 
−
**0.25-0.29 m<sup>2</sup> 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 m<sup>2</sup> 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 m<sup>2</sup> 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 m<sup>2</sup> 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 m<sup>2</sup> 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 m<sup>2</sup> 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 m<sup>2</sup> 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 m<sup>2</sup> BSA: 1.5 mg/m<sup>2</sup> (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 m<sup>2</sup> BSA: 220 mg IV over 60 minutes on day 1 of weeks 1 and 7
 
−
**0.3-0.34 m<sup>2</sup> BSA: 280 mg IV over 60 minutes on day 1 of weeks 1 and 7
 
−
**0.35-0.39 m<sup>2</sup> BSA: 360 mg IV over 60 minutes on day 1 of weeks 1 and 7
 
−
**0.4-0.44 m<sup>2</sup> BSA: 440 mg IV over 60 minutes on day 1 of weeks 1 and 7
 
−
**0.45-0.49 m<sup>2</sup> BSA: 520 mg IV over 60 minutes on day 1 of weeks 1 and 7
 
−
**0.5-0.54 m<sup>2</sup> BSA: 600 mg IV over 60 minutes on day 1 of weeks 1 and 7
 
−
**0.55-0.59 m<sup>2</sup> BSA: 660 mg IV over 60 minutes on day 1 of weeks 1 and 7
 
−
**≥ 0.6 m<sup>2</sup> BSA: 1200 mg/m<sup>2</sup> IV over 60 minutes on day 1 of weeks 1 and 7
 
−
*[[Irinotecan (Camptosar)]] by the following BSA-based criteria:
 
−
**0.25-0.29 m<sup>2</sup> BSA: 8 mg IV over 90 minutes once daily on days 1 through 5 of weeks 4 and 10
 
−
**0.3-0.34 m<sup>2</sup> BSA: 12 mg IV over 90 minutes once daily on days 1 through 5 of weeks 4 and 10
 
−
**0.35-0.39 m<sup>2</sup> BSA: 15 mg IV over 90 minutes once daily on days 1 through 5 of weeks 4 and 10
 
−
**0.4-0.44 m<sup>2</sup> BSA: 18 mg IV over 90 minutes once daily on days 1 through 5 of weeks 4 and 10
 
−
**0.45-0.49 m<sup>2</sup> BSA: 22 mg IV over 90 minutes once daily on days 1 through 5 of weeks 4 and 10
 
−
**0.5-0.54 m<sup>2</sup> BSA: 24 mg IV over 90 minutes once daily on days 1 through 5 of weeks 4 and 10
 
−
**0.55-0.59 m<sup>2</sup> BSA: 28 mg IV over 90 minutes once daily on days 1 through 5 of weeks 4 and 10
 
−
**≥ 0.6 m<sup>2</sup> BSA: 50 mg/m<sup>2</sup> 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 m<sup>2</sup> 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 m<sup>2</sup> 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 m<sup>2</sup> 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 m<sup>2</sup> 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 m<sup>2</sup> 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 m<sup>2</sup> 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 m<sup>2</sup> 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 m<sup>2</sup> BSA: 960 mg/m<sup>2</sup> 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
 
−
<div class="toccolours" style="background-color:#eeeeee">
 
−
===Protocol, Cycles 5-10 (Weeks 13 through 30)===
 
−
====Chemotherapy====
 
−
*[[Vincristine (Oncovin)]] by the following BSA-based criteria:
 
−
**0.25-0.29 m<sup>2</sup> 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 m<sup>2</sup> 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 m<sup>2</sup> 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 m<sup>2</sup> 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 m<sup>2</sup> 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 m<sup>2</sup> 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 m<sup>2</sup> 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 m<sup>2</sup> BSA: 1.5 mg/m<sup>2</sup> (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 m<sup>2</sup> BSA: 220 mg IV over 60 minutes on day 1 of weeks 13, 22, 28
 
−
**0.3-0.34 m<sup>2</sup> BSA: 280 mg IV over 60 minutes on day 1 of weeks 13, 22, 28
 
−
**0.35-0.39 m<sup>2</sup> BSA: 360 mg IV over 60 minutes on day 1 of weeks 13, 22, 28
 
−
**0.4-0.44 m<sup>2</sup> BSA: 440 mg IV over 60 minutes on day 1 of weeks 13, 22, 28
 
−
**0.45-0.49 m<sup>2</sup> BSA: 520 mg IV over 60 minutes on day 1 of weeks 13, 22, 28
 
−
**0.5-0.54 m<sup>2</sup> BSA: 600 mg IV over 60 minutes on day 1 of weeks 13, 22, 28
 
−
**0.55-0.59 m<sup>2</sup> BSA: 660 mg IV over 60 minutes on day 1 of weeks 13, 22, 28
 
−
**≥ 0.6 m<sup>2</sup> BSA: 1200 mg/m<sup>2</sup> IV over 60 minutes on day 1 of weeks 13, 22, 28
 
−
*[[Irinotecan (Camptosar)]] by the following BSA-based criteria:
 
−
**0.25-0.29 m<sup>2</sup> BSA: 8 mg IV over 90 minutes once daily on days 1 through 5 of weeks 16, 19, 25
 
−
**0.3-0.34 m<sup>2</sup> BSA: 12 mg IV over 90 minutes once daily on days 1 through 5 of weeks 16, 19, 25
 
−
**0.35-0.39 m<sup>2</sup> BSA: 15 mg IV over 90 minutes once daily on days 1 through 5 of weeks 16, 19, 25
 
−
**0.4-0.44 m<sup>2</sup> BSA: 18 mg IV over 90 minutes once daily on days 1 through 5 of weeks 16, 19, 25
 
−
**0.45-0.49 m<sup>2</sup> BSA: 22 mg IV over 90 minutes once daily on days 1 through 5 of weeks 16, 19, 25
 
−
**0.5-0.54 m<sup>2</sup> BSA: 24 mg IV over 90 minutes once daily on days 1 through 5 of weeks 16, 19, 25
 
−
**0.55-0.59 m<sup>2</sup> BSA: 28 mg IV over 90 minutes once daily on days 1 through 5 of weeks 16, 19, 25
 
−
**≥ 0.6 m<sup>2</sup> BSA: 50 mg/m<sup>2</sup> 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 m<sup>2</sup> 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 m<sup>2</sup> 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 m<sup>2</sup> 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 m<sup>2</sup> 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 m<sup>2</sup> 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 m<sup>2</sup> 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 m<sup>2</sup> 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 m<sup>2</sup> BSA: 960 mg/m<sup>2</sup> 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
 
−
<div class="toccolours" style="background-color:#eeeeee">
 
−
===Protocol, Cycles 11-14 (Weeks 31 through 42)===
 
−
====Chemotherapy====
 
−
*[[Vincristine (Oncovin)]] by the following BSA-based criteria:
 
−
**0.25-0.29 m<sup>2</sup> 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 m<sup>2</sup> 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 m<sup>2</sup> 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 m<sup>2</sup> 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 m<sup>2</sup> 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 m<sup>2</sup> 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 m<sup>2</sup> 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 m<sup>2</sup> BSA: 1.5 mg/m<sup>2</sup> (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 m<sup>2</sup> BSA: 220 mg IV over 60 minutes on day 1 of weeks 34, 40
 
−
**0.3-0.34 m<sup>2</sup> BSA: 280 mg IV over 60 minutes on day 1 of weeks 34, 40
 
−
**0.35-0.39 m<sup>2</sup> BSA: 360 mg IV over 60 minutes on day 1 of weeks 34, 40
 
−
**0.4-0.44 m<sup>2</sup> BSA: 440 mg IV over 60 minutes on day 1 of weeks 34, 40
 
−
**0.45-0.49 m<sup>2</sup> BSA: 520 mg IV over 60 minutes on day 1 of weeks 34, 40
 
−
**0.5-0.54 m<sup>2</sup> BSA: 600 mg IV over 60 minutes on day 1 of weeks 34, 40
 
−
**0.55-0.59 m<sup>2</sup> BSA: 660 mg IV over 60 minutes on day 1 of weeks 34, 40
 
−
**≥ 0.6 m<sup>2</sup> BSA: 1200 mg/m<sup>2</sup> IV over 60 minutes on day 1 of weeks 34, 40
 
−
*[[Irinotecan (Camptosar)]] by the following BSA-based criteria:
 
−
**0.25-0.29 m<sup>2</sup> BSA: 8 mg IV over 90 minutes once daily on days 1 through 5 of weeks 31, 37
 
−
**0.3-0.34 m<sup>2</sup> BSA: 12 mg IV over 90 minutes once daily on days 1 through 5 of weeks 31, 37
 
−
**0.35-0.39 m<sup>2</sup> BSA: 15 mg IV over 90 minutes once daily on days 1 through 5 of weeks 31, 37
 
−
**0.4-0.44 m<sup>2</sup> BSA: 18 mg IV over 90 minutes once daily on days 1 through 5 of weeks 31, 37
 
−
**0.45-0.49 m<sup>2</sup> BSA: 22 mg IV over 90 minutes once daily on days 1 through 5 of weeks 31, 37
 
−
**0.5-0.54 m<sup>2</sup> BSA: 24 mg IV over 90 minutes once daily on days 1 through 5 of weeks 31, 37
 
−
**0.55-0.59 m<sup>2</sup> BSA: 28 mg IV over 90 minutes once daily on days 1 through 5 of weeks 31, 37
 
−
**≥ 0.6 m<sup>2</sup> BSA: 50 mg/m<sup>2</sup> 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 m<sup>2</sup> 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 m<sup>2</sup> 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 m<sup>2</sup> 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 m<sup>2</sup> 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 m<sup>2</sup> 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 m<sup>2</sup> 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 m<sup>2</sup> 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 m<sup>2</sup> BSA: 960 mg/m<sup>2</sup> 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
 
−
<div class="toccolours" style="background-color:#eeeeee">
 
−
===Protocol, Maintenance Cycles 1-6===
 
−
====Chemotherapy====
 
−
*[[Vinorelbine (Navelbine)]] by the following BSA-based criteria:
 
−
**0.25-0.29 m<sup>2</sup> BSA: 4 mg IV push over 6 to 10 minutes on days 1, 8, and 15
 
−
**0.3-0.34 m<sup>2</sup> BSA: 6 mg IV push over 6 to 10 minutes on days 1, 8, and 15
 
−
**0.35-0.39 m<sup>2</sup> BSA: 7.5 mg IV push over 6 to 10 minutes on days 1, 8, and 15
 
−
**0.4-0.44 m<sup>2</sup> BSA: 9 mg IV push over 6 to 10 minutes on days 1, 8, and 15
 
−
**0.45-0.49 m<sup>2</sup> BSA: 11 mg IV push over 6 to 10 minutes on days 1, 8, and 15
 
−
**0.5-0.54 m<sup>2</sup> BSA: 12 mg IV push over 6 to 10 minutes on days 1, 8, and 15
 
−
**0.55-0.59 m<sup>2</sup> BSA: 14 mg IV push over 6 to 10 minutes on days 1, 8, and 15
 
−
**≥ 0.6 m<sup>2</sup> BSA: 25 mg/m<sup>2</sup> IV push over 6 to 10 minutes on days 1, 8, and 15
 
−
*[[Cyclophosphamide (Cytoxan)]] 25 mg/m<sup>2</sup> PO once daily on days 1 through 28
 
−
**Dose rounded to the nearest 25 mg capsule
 
−
'''28-day cycle'''
 
−
</div></div>
 
−
===References===
 
−
# '''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. [https://doi.org/10.1016/S1470-2045(19)30617-5 link to original article] [https://pubmed.ncbi.nlm.nih.gov/31562043/ PubMed]
 
−
# '''COG ARST1431:''' [https://clinicaltrials.gov/ct2/show/NCT02567435 NCT02567435]
 
−
==COG ARST1431 Protocol B (VAC/VI Plus TORI)==
 
−
<div class="toccolours" style="background-color:#eeeeee">
 
−
===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/m<sup>2</sup> (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 m<sup>2</sup> 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 m<sup>2</sup> 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 m<sup>2</sup> 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 m<sup>2</sup> 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 m<sup>2</sup> 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 m<sup>2</sup> 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 m<sup>2</sup> 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 m<sup>2</sup> BSA: 1.5 mg/m<sup>2</sup> (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 m<sup>2</sup> BSA: 220 mg IV over 60 minutes on day 1 of weeks 1 and 7
 
−
**0.3-0.34 m<sup>2</sup> BSA: 280 mg IV over 60 minutes on day 1 of weeks 1 and 7
 
−
**0.35-0.39 m<sup>2</sup> BSA: 360 mg IV over 60 minutes on day 1 of weeks 1 and 7
 
−
**0.4-0.44 m<sup>2</sup> BSA: 440 mg IV over 60 minutes on day 1 of weeks 1 and 7
 
−
**0.45-0.49 m<sup>2</sup> BSA: 520 mg IV over 60 minutes on day 1 of weeks 1 and 7
 
−
**0.5-0.54 m<sup>2</sup> BSA: 600 mg IV over 60 minutes on day 1 of weeks 1 and 7
 
−
**0.55-0.59 m<sup>2</sup> BSA: 660 mg IV over 60 minutes on day 1 of weeks 1 and 7
 
−
**≥ 0.6 m<sup>2</sup> BSA: 1200 mg/m<sup>2</sup> IV over 60 minutes on day 1 of weeks 1 and 7
 
−
*[[Irinotecan (Camptosar)]] by the following BSA-based criteria:
 
−
**0.25-0.29 m<sup>2</sup> BSA: 8 mg IV over 90 minutes once daily on days 1 through 5 of weeks 4 and 10
 
−
**0.3-0.34 m<sup>2</sup> BSA: 12 mg IV over 90 minutes once daily on days 1 through 5 of weeks 4 and 10
 
−
**0.35-0.39 m<sup>2</sup> BSA: 15 mg IV over 90 minutes once daily on days 1 through 5 of weeks 4 and 10
 
−
**0.4-0.44 m<sup>2</sup> BSA: 18 mg IV over 90 minutes once daily on days 1 through 5 of weeks 4 and 10
 
−
**0.45-0.49 m<sup>2</sup> BSA: 22 mg IV over 90 minutes once daily on days 1 through 5 of weeks 4 and 10
 
−
**0.5-0.54 m<sup>2</sup> BSA: 24 mg IV over 90 minutes once daily on days 1 through 5 of weeks 4 and 10
 
−
**0.55-0.59 m<sup>2</sup> BSA: 28 mg IV over 90 minutes once daily on days 1 through 5 of weeks 4 and 10
 
−
**≥ 0.6 m<sup>2</sup> BSA: 50 mg/m<sup>2</sup> 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 m<sup>2</sup> 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 m<sup>2</sup> 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 m<sup>2</sup> 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 m<sup>2</sup> 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 m<sup>2</sup> 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 m<sup>2</sup> 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 m<sup>2</sup> 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 m<sup>2</sup> BSA: 960 mg/m<sup>2</sup> IV over 15 to 30 minutes immediately before [[Cyclophosphamide (Cytoxan)]] infusion, and again 4 and 8 hours after the start of [[Cyclophosphamide (Cytoxan)]] infusion
 
−
<div class="toccolours" style="background-color:#eeeeee">
 
−
===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/m<sup>2</sup> (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 m<sup>2</sup> 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 m<sup>2</sup> 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 m<sup>2</sup> 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 m<sup>2</sup> 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 m<sup>2</sup> 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 m<sup>2</sup> 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 m<sup>2</sup> 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 m<sup>2</sup> BSA: 1.5 mg/m<sup>2</sup> (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 m<sup>2</sup> BSA: 220 mg IV over 60 minutes on day 1 of weeks 13, 22, 28
 
−
**0.3-0.34 m<sup>2</sup> BSA: 280 mg IV over 60 minutes on day 1 of weeks 13, 22, 28
 
−
**0.35-0.39 m<sup>2</sup> BSA: 360 mg IV over 60 minutes on day 1 of weeks 13, 22, 28
 
−
**0.4-0.44 m<sup>2</sup> BSA: 440 mg IV over 60 minutes on day 1 of weeks 13, 22, 28
 
−
**0.45-0.49 m<sup>2</sup> BSA: 520 mg IV over 60 minutes on day 1 of weeks 13, 22, 28
 
−
**0.5-0.54 m<sup>2</sup> BSA: 600 mg IV over 60 minutes on day 1 of weeks 13, 22, 28
 
−
**0.55-0.59 m<sup>2</sup> BSA: 660 mg IV over 60 minutes on day 1 of weeks 13, 22, 28
 
−
**≥ 0.6 m<sup>2</sup> BSA: 1200 mg/m<sup>2</sup> IV over 60 minutes on day 1 of weeks 13, 22, 28
 
−
*[[Irinotecan (Camptosar)]] by the following BSA-based criteria:
 
−
**0.25-0.29 m<sup>2</sup> BSA: 8 mg IV over 90 minutes once daily on days 1 through 5 of weeks 16, 19, 25
 
−
**0.3-0.34 m<sup>2</sup> BSA: 12 mg IV over 90 minutes once daily on days 1 through 5 of weeks 16, 19, 25
 
−
**0.35-0.39 m<sup>2</sup> BSA: 15 mg IV over 90 minutes once daily on days 1 through 5 of weeks 16, 19, 25
 
−
**0.4-0.44 m<sup>2</sup> BSA: 18 mg IV over 90 minutes once daily on days 1 through 5 of weeks 16, 19, 25
 
−
**0.45-0.49 m<sup>2</sup> BSA: 22 mg IV over 90 minutes once daily on days 1 through 5 of weeks 16, 19, 25
 
−
**0.5-0.54 m<sup>2</sup> BSA: 24 mg IV over 90 minutes once daily on days 1 through 5 of weeks 16, 19, 25
 
−
**0.55-0.59 m<sup>2</sup> BSA: 28 mg IV over 90 minutes once daily on days 1 through 5 of weeks 16, 19, 25
 
−
**≥ 0.6 m<sup>2</sup> BSA: 50 mg/m<sup>2</sup> 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 m<sup>2</sup> 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 m<sup>2</sup> 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 m<sup>2</sup> 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 m<sup>2</sup> 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 m<sup>2</sup> 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 m<sup>2</sup> 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 m<sup>2</sup> 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 m<sup>2</sup> BSA: 960 mg/m<sup>2</sup> IV over 15 to 30 minutes immediately before [[Cyclophosphamide (Cytoxan)]] infusion, and again 4 and 8 hours after the start of [[Cyclophosphamide (Cytoxan)]] infusion
 
−
<div class="toccolours" style="background-color:#eeeeee">
 
−
===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/m<sup>2</sup> (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 m<sup>2</sup> 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 m<sup>2</sup> 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 m<sup>2</sup> 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 m<sup>2</sup> 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 m<sup>2</sup> 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 m<sup>2</sup> 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 m<sup>2</sup> 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 m<sup>2</sup> BSA: 1.5 mg/m<sup>2</sup> (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 m<sup>2</sup> BSA: 220 mg IV over 60 minutes on day 1 of weeks 34, 40
 
−
**0.3-0.34 m<sup>2</sup> BSA: 280 mg IV over 60 minutes on day 1 of weeks 34, 40
 
−
**0.35-0.39 m<sup>2</sup> BSA: 360 mg IV over 60 minutes on day 1 of weeks 34, 40
 
−
**0.4-0.44 m<sup>2</sup> BSA: 440 mg IV over 60 minutes on day 1 of weeks 34, 40
 
−
**0.45-0.49 m<sup>2</sup> BSA: 520 mg IV over 60 minutes on day 1 of weeks 34, 40
 
−
**0.5-0.54 m<sup>2</sup> BSA: 600 mg IV over 60 minutes on day 1 of weeks 34, 40
 
−
**0.55-0.59 m<sup>2</sup> BSA: 660 mg IV over 60 minutes on day 1 of weeks 34, 40
 
−
**≥ 0.6 m<sup>2</sup> BSA: 1200 mg/m<sup>2</sup> IV over 60 minutes on day 1 of weeks 34, 40
 
−
*[[Irinotecan (Camptosar)]] by the following BSA-based criteria:
 
−
**0.25-0.29 m<sup>2</sup> BSA: 8 mg IV over 90 minutes once daily on days 1 through 5 of weeks 31, 37
 
−
**0.3-0.34 m<sup>2</sup> BSA: 12 mg IV over 90 minutes once daily on days 1 through 5 of weeks 31, 37
 
−
**0.35-0.39 m<sup>2</sup> BSA: 15 mg IV over 90 minutes once daily on days 1 through 5 of weeks 31, 37
 
−
**0.4-0.44 m<sup>2</sup> BSA: 18 mg IV over 90 minutes once daily on days 1 through 5 of weeks 31, 37
 
−
**0.45-0.49 m<sup>2</sup> BSA: 22 mg IV over 90 minutes once daily on days 1 through 5 of weeks 31, 37
 
−
**0.5-0.54 m<sup>2</sup> BSA: 24 mg IV over 90 minutes once daily on days 1 through 5 of weeks 31, 37
 
−
**0.55-0.59 m<sup>2</sup> BSA: 28 mg IV over 90 minutes once daily on days 1 through 5 of weeks 31, 37
 
−
**≥ 0.6 m<sup>2</sup> BSA: 50 mg/m<sup>2</sup> 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 m<sup>2</sup> 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 m<sup>2</sup> 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 m<sup>2</sup> 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 m<sup>2</sup> 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 m<sup>2</sup> 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 m<sup>2</sup> 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 m<sup>2</sup> 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 m<sup>2</sup> BSA: 960 mg/m<sup>2</sup> IV over 15 to 30 minutes immediately before [[Cyclophosphamide (Cytoxan)]] infusion, and again 4 and 8 hours after the start of [[Cyclophosphamide (Cytoxan)]] infusion
 
−
<div class="toccolours" style="background-color:#eeeeee">
 
−
===Protocol, Maintenance Cycles 1-6===
 
−
====Chemotherapy====
 
−
*[[Vinorelbine (Navelbine)]] by the following BSA-based criteria:
 
−
**0.25-0.29 m<sup>2</sup> BSA: 4 mg IV push over 6 to 10 minutes on days 1, 8, and 15
 
−
**0.3-0.34 m<sup>2</sup> BSA: 6 mg IV push over 6 to 10 minutes on days 1, 8, and 15
 
−
**0.35-0.39 m<sup>2</sup> BSA: 7.5 mg IV push over 6 to 10 minutes on days 1, 8, and 15
 
−
**0.4-0.44 m<sup>2</sup> BSA: 9 mg IV push over 6 to 10 minutes on days 1, 8, and 15
 
−
**0.45-0.49 m<sup>2</sup> BSA: 11 mg IV push over 6 to 10 minutes on days 1, 8, and 15
 
−
**0.5-0.54 m<sup>2</sup> BSA: 12 mg IV push over 6 to 10 minutes on days 1, 8, and 15
 
−
**0.55-0.59 m<sup>2</sup> BSA: 14 mg IV push over 6 to 10 minutes on days 1, 8, and 15
 
−
**≥ 0.6 m<sup>2</sup> BSA: 25 mg/m<sup>2</sup> IV push over 6 to 10 minutes on days 1, 8, and 15
 
−
*[[Cyclophosphamide (Cytoxan)]] 25 mg/m<sup>2</sup> PO once daily on days 1 through 28
 
−
**Dose rounded to the nearest 25 mg capsule
 
−
'''28-day cycle'''
 
−
</div></div>
 
−
===References===
 
−
# '''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. [https://doi.org/10.1016/S1470-2045(19)30617-5 link to original article] [https://pubmed.ncbi.nlm.nih.gov/31562043/ PubMed]
 
−
# '''COG ARST1431:''' [https://clinicaltrials.gov/ct2/show/NCT02567435 NCT02567435]
 
−
==COG ARST0531 VAC Arm==
 
−
<div class="toccolours" style="background-color:#eeeeee">
 
−
===Protocol, Weeks 1-15===
 
−
====Chemotherapy, Week 1====
 
−
*[[Vincristine (Oncovin)]] by the following age-based criteria:
 
−
**Age ≥ 3 years: 1.5 mg/m<sup>2</sup> (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/m<sup>2</sup> 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/m<sup>2</sup> 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/m<sup>2</sup> (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/m<sup>2</sup> (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/m<sup>2</sup> (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/m<sup>2</sup> 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/m<sup>2</sup> 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/m<sup>2</sup> (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/m<sup>2</sup> (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/m<sup>2</sup> (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/m<sup>2</sup> 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/m<sup>2</sup> 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/m<sup>2</sup> (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/m<sup>2</sup> (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/m<sup>2</sup> (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/m<sup>2</sup> 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/m<sup>2</sup> 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/m<sup>2</sup> (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/m<sup>2</sup> (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/m<sup>2</sup> (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/m<sup>2</sup> 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/m<sup>2</sup> 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 14 Off Chemo====
 
−
====Chemotherapy, Week 15 Evaluation====
 
−
<div class="toccolours" style="background-color:#eeeeee">
 
−
===Protocol, Weeks 16-30===
 
−
====Chemotherapy, Week 16====
 
−
*[[Vincristine (Oncovin)]] by the following age-based criteria:
 
−
**Age ≥ 3 years: 1.5 mg/m<sup>2</sup> (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/m<sup>2</sup> 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/m<sup>2</sup> 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 17 Off Chemo====
 
−
====Chemotherapy, Week 18 Off Chemo====
 
−
====Chemotherapy, Week 19====
 
−
*[[Vincristine (Oncovin)]] by the following age-based criteria:
 
−
**Age ≥ 3 years: 1.5 mg/m<sup>2</sup> (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/m<sup>2</sup> 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/m<sup>2</sup> 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/m<sup>2</sup> (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/m<sup>2</sup> (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/m<sup>2</sup> (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/m<sup>2</sup> 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/m<sup>2</sup> 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/m<sup>2</sup> (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/m<sup>2</sup> (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/m<sup>2</sup> (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/m<sup>2</sup> 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/m<sup>2</sup> 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 26 Off Chemo====
 
−
====Chemotherapy, Week 27 Off Chemo====
 
−
====Chemotherapy, Week 28====
 
−
*[[Vincristine (Oncovin)]] by the following age-based criteria:
 
−
**Age ≥ 3 years: 1.5 mg/m<sup>2</sup> (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/m<sup>2</sup> 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/m<sup>2</sup> 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 Off Chemo====
 
−
====Chemotherapy, Week 30 Evaluation====
 
−
<div class="toccolours" style="background-color:#eeeeee">
 
−
===Protocol, Weeks 31-43===
 
−
====Chemotherapy, Week 31====
 
−
*[[Vincristine (Oncovin)]] by the following age-based criteria:
 
−
**Age ≥ 3 years: 1.5 mg/m<sup>2</sup> (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/m<sup>2</sup> 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/m<sup>2</sup> 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/m<sup>2</sup> (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/m<sup>2</sup> (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/m<sup>2</sup> (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/m<sup>2</sup> 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/m<sup>2</sup> 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/m<sup>2</sup> (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/m<sup>2</sup> (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/m<sup>2</sup> (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/m<sup>2</sup> 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/m<sup>2</sup> 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 Off Chemo====
 
−
====Chemotherapy, Week 39 Off Chemo====
 
−
====Chemotherapy, Week 40====
 
−
*[[Vincristine (Oncovin)]] by the following age-based criteria:
 
−
**Age ≥ 3 years: 1.5 mg/m<sup>2</sup> (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/m<sup>2</sup> 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/m<sup>2</sup> 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 Off Chemo====
 
−
====Chemotherapy, Week 42 Off Chemo====
 
−
====Chemotherapy, Week 43 Evaluation====
 
−
</div></div>
 
−
===References===
 
−
# '''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. [https://doi.org/10.1200/JCO.2018.77.9694 link to original article] [https://pubmed.ncbi.nlm.nih.gov/30091945/ PubMed] [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6145831/ PMC Article] NCT01222715
 
−
==COG ARST0531 VAC/VI Arm==
 
−
<div class="toccolours" style="background-color:#eeeeee">
 
−
===Protocol, Weeks 1-15===
 
−
====Chemotherapy, Week 1====
 
−
*[[Vincristine (Oncovin)]] by the following age-based criteria:
 
−
**Age ≥ 3 years: 1.5 mg/m<sup>2</sup> (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/m<sup>2</sup> 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/m<sup>2</sup> 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/m<sup>2</sup> (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/m<sup>2</sup> (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/m<sup>2</sup> (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/m<sup>2</sup> (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/m<sup>2</sup> (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/m<sup>2</sup> (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/m<sup>2</sup> (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/m<sup>2</sup> (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/m<sup>2</sup> (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/m<sup>2</sup> (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/m<sup>2</sup> (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/m<sup>2</sup> 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/m<sup>2</sup> 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/m<sup>2</sup> (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/m<sup>2</sup> (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/m<sup>2</sup> (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/m<sup>2</sup> 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/m<sup>2</sup> 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 14 Off Chemo====
 
−
====Chemotherapy, Week 15 Evaluation====
 
−
<div class="toccolours" style="background-color:#eeeeee">
 
−
===Protocol, Weeks 16-30===
 
−
====Chemotherapy, Week 16====
 
−
*[[Vincristine (Oncovin)]] by the following age-based criteria:
 
−
**Age ≥ 3 years: 1.5 mg/m<sup>2</sup> (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/m<sup>2</sup> (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/m<sup>2</sup> (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 18 Off Chemo====
 
−
====Chemotherapy, Week 19====
 
−
*[[Vincristine (Oncovin)]] by the following age-based criteria:
 
−
**Age ≥ 3 years: 1.5 mg/m<sup>2</sup> (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/m<sup>2</sup> (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/m<sup>2</sup> (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 Off Chemo====
 
−
====Chemotherapy, Week 22====
 
−
*[[Vincristine (Oncovin)]] by the following age-based criteria:
 
−
**Age ≥ 3 years: 1.5 mg/m<sup>2</sup> (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/m<sup>2</sup> 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/m<sup>2</sup> 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/m<sup>2</sup> (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/m<sup>2</sup> (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/m<sup>2</sup> (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/m<sup>2</sup> (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/m<sup>2</sup> (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 27 Off Chemo====
 
−
====Chemotherapy, Week 28====
 
−
*[[Vincristine (Oncovin)]] by the following age-based criteria:
 
−
**Age ≥ 3 years: 1.5 mg/m<sup>2</sup> (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/m<sup>2</sup> 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/m<sup>2</sup> 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 Off Chemo====
 
−
====Chemotherapy, Week 30 Evaluation====
 
−
<div class="toccolours" style="background-color:#eeeeee">
 
−
===Protocol, Weeks 31-43===
 
−
====Chemotherapy, Week 31====
 
−
*[[Vincristine (Oncovin)]] by the following age-based criteria:
 
−
**Age ≥ 3 years: 1.5 mg/m<sup>2</sup> (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/m<sup>2</sup> (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/m<sup>2</sup> (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/m<sup>2</sup> (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/m<sup>2</sup> (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/m<sup>2</sup> 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/m<sup>2</sup> 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 Off Chemo====
 
−
====Chemotherapy, Week 36 Off Chemo====
 
−
====Chemotherapy, Week 37====
 
−
*[[Vincristine (Oncovin)]] by the following age-based criteria:
 
−
**Age ≥ 3 years: 1.5 mg/m<sup>2</sup> (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/m<sup>2</sup> (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/m<sup>2</sup> (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 39 Off Chemo====
 
−
====Chemotherapy, Week 40====
 
−
*[[Vincristine (Oncovin)]] by the following age-based criteria:
 
−
**Age ≥ 3 years: 1.5 mg/m<sup>2</sup> (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/m<sup>2</sup> 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/m<sup>2</sup> 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 Off Chemo====
 
−
====Chemotherapy, Week 42 Off Chemo====
 
−
====Chemotherapy, Week 43 Evaluation====
 
−
</div></div>
 
−
===References===
 
−
# '''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. [https://doi.org/10.1200/JCO.2018.77.9694 link to original article] [https://pubmed.ncbi.nlm.nih.gov/30091945/ PubMed] [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6145831/ PMC Article] NCT01222715
 
−
=Low Risk=
 
−
==COG ARST1431 Protocol C (VAC/VA Only)==
 
−
<div class="toccolours" style="background-color:#eeeeee">
 
−
===Protocol, Cycles 1-4 (Weeks 1 through 12)===
 
−
====Chemotherapy====
 
−
*[[Vincristine (Oncovin)]] by the following BSA-based criteria:
 
−
**0.25-0.29 m<sup>2</sup> 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 m<sup>2</sup> 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 m<sup>2</sup> 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 m<sup>2</sup> 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 m<sup>2</sup> 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 m<sup>2</sup> 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 m<sup>2</sup> 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 m<sup>2</sup> BSA: 1.5 mg/m<sup>2</sup> (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 m<sup>2</sup> BSA: 220 mg IV over 60 minutes on day 1 of weeks 1, 4, 7, 10
 
−
**0.3-0.34 m<sup>2</sup> BSA: 280 mg IV over 60 minutes on day 1 of weeks 1, 4, 7, 10
 
−
**0.35-0.39 m<sup>2</sup> BSA: 360 mg IV over 60 minutes on day 1 of weeks 1, 4, 7, 10
 
−
**0.4-0.44 m<sup>2</sup> BSA: 440 mg IV over 60 minutes on day 1 of weeks 1, 4, 7, 10
 
−
**0.45-0.49 m<sup>2</sup> BSA: 520 mg IV over 60 minutes on day 1 of weeks 1, 4, 7, 10
 
−
**0.5-0.54 m<sup>2</sup> BSA: 600 mg IV over 60 minutes on day 1 of weeks 1, 4, 7, 10
 
−
**0.55-0.59 m<sup>2</sup> BSA: 660 mg IV over 60 minutes on day 1 of weeks 1, 4, 7, 10
 
−
**≥ 0.6 m<sup>2</sup> BSA: 1200 mg/m<sup>2</sup> 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 m<sup>2</sup> 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 m<sup>2</sup> 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 m<sup>2</sup> 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 m<sup>2</sup> 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 m<sup>2</sup> 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 m<sup>2</sup> 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 m<sup>2</sup> 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 m<sup>2</sup> BSA: 960 mg/m<sup>2</sup> 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
 
−
<div class="toccolours" style="background-color:#eeeeee">
 
−
===Protocol, Cycles 5-8 (Weeks 13 through 24)===
 
−
====Chemotherapy====
 
−
*[[Vincristine (Oncovin)]] by the following BSA-based criteria:
 
−
**0.25-0.29 m<sup>2</sup> 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 m<sup>2</sup> 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 m<sup>2</sup> 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 m<sup>2</sup> 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 m<sup>2</sup> 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 m<sup>2</sup> 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 m<sup>2</sup> 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 m<sup>2</sup> BSA: 1.5 mg/m<sup>2</sup> (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
 
−
</div></div>
 
−
===References===
 
−
# '''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. [https://doi.org/10.1016/S1470-2045(19)30617-5 link to original article] [https://pubmed.ncbi.nlm.nih.gov/31562043/ PubMed]
 
−
# '''COG ARST1431:''' [https://clinicaltrials.gov/ct2/show/NCT02567435 NCT02567435]
 
−
==COG ARST0331 (In Process)==
 
−
=High Risk=
 
−
==COG ARST0431==
 
−
<div class="toccolours" style="background-color:#eeeeee">
 
−
===Protocol, Weeks 1-6===
 
−
====Chemotherapy, Week 1 (IRIN-VCR)====
 
−
*[[Vincristine (Oncovin)]] by the following age-based criteria:
 
−
**Age ≥ 3 years: 1.5 mg/m<sup>2</sup> (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/m<sup>2</sup> (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/m<sup>2</sup> (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/m<sup>2</sup> (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/m<sup>2</sup> (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/m<sup>2</sup> (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/m<sup>2</sup> (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 Evaluation====
 
−
<div class="toccolours" style="background-color:#eeeeee">
 
−
===Protocol, Weeks 7-19===
 
−
====Chemotherapy, Week 7 (VDC)====
 
−
*[[Vincristine (Oncovin)]] by the following age-based criteria:
 
−
**Age ≥ 3 years: 1.5 mg/m<sup>2</sup> (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/m<sup>2</sup> (Total dose per week of 75 mg/m<sup>2</sup>) IV over 24 hours once per day on days 1 through 2
 
−
**Age < 1 year: 18.75 mg/m<sup>2</sup> 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/m<sup>2</sup> 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/m<sup>2</sup> 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/m<sup>2</sup> (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/m<sup>2</sup> IV over 1 hour once per day on days 1 through 5
 
−
**Age < 1 year: 900 mg/m<sup>2</sup> 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/m<sup>2</sup> IV over 30 to 60 minutes once per day on days 1 through 5
 
−
**Age < 1 year: 50 mg/m<sup>2</sup> 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/m<sup>2</sup> at hour 0, 4, and 8 from the start of each [[Ifosfamide (Ifex)]] infusion on days 1 through 5
 
−
**Age < 3 years: 180 mg/m<sup>2</sup> at hour 0, 4, and 8 from the start of each [[Ifosfamide (Ifex)]] infusion on days 1 through 5
 
−
====Chemotherapy, Week 10 Off Chemo====
 
−
====Chemotherapy, Week 11 (VDC)====
 
−
*[[Vincristine (Oncovin)]] by the following age-based criteria:
 
−
**Age ≥ 3 years: 1.5 mg/m<sup>2</sup> (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/m<sup>2</sup> (Total dose per week of 75 mg/m<sup>2</sup>) IV over 24 hours once per day on days 1 through 2
 
−
**Age < 1 year: 18.75 mg/m<sup>2</sup> 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/m<sup>2</sup> 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/m<sup>2</sup> 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/m<sup>2</sup> (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/m<sup>2</sup> IV over 1 hour once per day on days 1 through 5
 
−
**Age < 1 year: 900 mg/m<sup>2</sup> 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/m<sup>2</sup> IV over 30 to 60 minutes once per day on days 1 through 5
 
−
**Age < 1 year: 50 mg/m<sup>2</sup> 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/m<sup>2</sup> at hour 0, 4, and 8 from the start of each [[Ifosfamide (Ifex)]] infusion on days 1 through 5
 
−
**Age < 3 years: 180 mg/m<sup>2</sup> at hour 0, 4, and 8 from the start of each [[Ifosfamide (Ifex)]] infusion on days 1 through 5
 
−
====Chemotherapy, Week 14 Off Chemo====
 
−
====Chemotherapy, Week 15 (VDC)====
 
−
*[[Vincristine (Oncovin)]] by the following age-based criteria:
 
−
**Age ≥ 3 years: 1.5 mg/m<sup>2</sup> (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/m<sup>2</sup> (Total dose per week of 75 mg/m<sup>2</sup>) IV over 24 hours once per day on days 1 through 2
 
−
**Age < 1 year: 18.75 mg/m<sup>2</sup> 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/m<sup>2</sup> 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/m<sup>2</sup> 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/m<sup>2</sup> (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/m<sup>2</sup> IV over 1 hour once per day on days 1 through 5
 
−
**Age < 1 year: 900 mg/m<sup>2</sup> 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/m<sup>2</sup> IV over 30 to 60 minutes once per day on days 1 through 5
 
−
**Age < 1 year: 50 mg/m<sup>2</sup> 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/m<sup>2</sup> at hour 0, 4, and 8 from the start of each [[Ifosfamide (Ifex)]] infusion on days 1 through 5
 
−
**Age < 3 years: 180 mg/m<sup>2</sup> at hour 0, 4, and 8 from the start of each [[Ifosfamide (Ifex)]] infusion on days 1 through 5
 
−
====Chemotherapy, Week 18 Off Chemo====
 
−
====Chemotherapy, Week 19 Evaluation====
 
−
<div class="toccolours" style="background-color:#eeeeee">
 
−
===Protocol, Weeks 20-34===
 
−
====Chemotherapy, Week 20 (IRIN-VCR)====
 
−
*[[Vincristine (Oncovin)]] by the following age-based criteria:
 
−
**Age ≥ 3 years: 1.5 mg/m<sup>2</sup> (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/m<sup>2</sup> (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/m<sup>2</sup> (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/m<sup>2</sup> (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/m<sup>2</sup> (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/m<sup>2</sup> (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/m<sup>2</sup> (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 Off Chemo====
 
−
====Chemotherapy, Week 26 (IE)====
 
−
*[[Ifosfamide (Ifex)]] by the following age-based criteria:
 
−
**Age ≥ 1 year: 1800 mg/m<sup>2</sup> IV over 1 hour once per day on days 1 through 5
 
−
**Age < 1 year: 900 mg/m<sup>2</sup> 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/m<sup>2</sup> IV over 30 to 60 minutes once per day on days 1 through 5
 
−
**Age < 1 year: 50 mg/m<sup>2</sup> 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/m<sup>2</sup> at hour 0, 4, and 8 from the start of each [[Ifosfamide (Ifex)]] infusion on days 1 through 5
 
−
**Age < 3 years: 180 mg/m<sup>2</sup> at hour 0, 4, and 8 from the start of each [[Ifosfamide (Ifex)]] infusion on days 1 through 5
 
−
====Chemotherapy, Week 27 Off Chemo====
 
−
====Chemotherapy, Week 28 (VDC)====
 
−
*[[Vincristine (Oncovin)]] by the following age-based criteria:
 
−
**Age ≥ 3 years: 1.5 mg/m<sup>2</sup> (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/m<sup>2</sup> (Total dose per week of 75 mg/m<sup>2</sup>) IV over 24 hours once per day on days 1 through 2
 
−
**Age < 1 year: 18.75 mg/m<sup>2</sup> 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/m<sup>2</sup> 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/m<sup>2</sup> 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/m<sup>2</sup> (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/m<sup>2</sup> IV over 1 hour once per day on days 1 through 5
 
−
**Age < 1 year: 900 mg/m<sup>2</sup> 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/m<sup>2</sup> IV over 30 to 60 minutes once per day on days 1 through 5
 
−
**Age < 1 year: 50 mg/m<sup>2</sup> 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/m<sup>2</sup> at hour 0, 4, and 8 from the start of each [[Ifosfamide (Ifex)]] infusion on days 1 through 5
 
−
**Age < 3 years: 180 mg/m<sup>2</sup> at hour 0, 4, and 8 from the start of each [[Ifosfamide (Ifex)]] infusion on days 1 through 5
 
−
====Chemotherapy, Week 31 Off Chemo====
 
−
====Chemotherapy, Week 32 (VDC)====
 
−
*[[Vincristine (Oncovin)]] by the following age-based criteria:
 
−
**Age ≥ 3 years: 1.5 mg/m<sup>2</sup> (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/m<sup>2</sup> (Total dose per week of 75 mg/m<sup>2</sup>) IV over 24 hours once per day on days 1 through 2
 
−
**Age < 1 year: 18.75 mg/m<sup>2</sup> 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/m<sup>2</sup> 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/m<sup>2</sup> 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/m<sup>2</sup> (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 Evaluation====
 
−
<div class="toccolours" style="background-color:#eeeeee">
 
−
===Protocol, Weeks 35-54===
 
−
====Chemotherapy, Week 35 (VAC)====
 
−
*[[Vincristine (Oncovin)]] by the following age-based criteria:
 
−
**Age ≥ 3 years: 1.5 mg/m<sup>2</sup> (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/m<sup>2</sup> 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/m<sup>2</sup> 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 36 Off Chemo====
 
−
====Chemotherapy, Week 37 Off Chemo====
 
−
====Chemotherapy, Week 38 (VAC)====
 
−
*[[Vincristine (Oncovin)]] by the following age-based criteria:
 
−
**Age ≥ 3 years: 1.5 mg/m<sup>2</sup> (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/m<sup>2</sup> 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/m<sup>2</sup> 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 39 Off Chemo====
 
−
====Chemotherapy, Week 40 Off Chemo====
 
−
====Chemotherapy, Week 41 (VAC)====
 
−
*[[Vincristine (Oncovin)]] by the following age-based criteria:
 
−
**Age ≥ 3 years: 1.5 mg/m<sup>2</sup> (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/m<sup>2</sup> 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/m<sup>2</sup> 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/m<sup>2</sup> (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/m<sup>2</sup> (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/m<sup>2</sup> (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/m<sup>2</sup> 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/m<sup>2</sup> 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 45 Off Chemo====
 
−
====Chemotherapy, Week 46 Off Chemo====
 
−
====Chemotherapy, Week 47 (IRIN-VCR)====
 
−
*[[Vincristine (Oncovin)]] by the following age-based criteria:
 
−
**Age ≥ 3 years: 1.5 mg/m<sup>2</sup> (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/m<sup>2</sup> (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/m<sup>2</sup> (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 49 Off Chemo====
 
−
====Chemotherapy, Week 50 (IRIN-VCR)====
 
−
*[[Vincristine (Oncovin)]] by the following age-based criteria:
 
−
**Age ≥ 3 years: 1.5 mg/m<sup>2</sup> (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/m<sup>2</sup> (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/m<sup>2</sup> (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 52 Off Chemo====
 
−
====Chemotherapy, Week 53 Off Chemo====
 
−
====Chemotherapy, Week 54 Evaluation====
 
−
</div></div>
 
−
===References===
 
−
# '''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. [https://doi.org/10.1200/jco.2015.63.4048 link to original article] [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5070550/ link to PMC article] [https://pubmed.ncbi.nlm.nih.gov/26503200/ PubMed] NCT00354744
 
−
[[Category:Disease-specific pages]]
 
−
[[Category:Bone sarcomas]]
 
−
[[Category:Pediatric solid tumors]]
 

Latest revision as of 00:13, 18 June 2023

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