Difference between revisions of "Ewing sarcoma, pediatric - historical"
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=Upfront therapy, localized disease= | =Upfront therapy, localized disease= | ||
| − | ==COG AEWS0031== | + | ==COG AEWS0031 Induction A== |
| − | ===Regimen | + | ===Regimen=== |
*Regimen A is a standard regimen consisting of 21 day cycles | *Regimen A is a standard regimen consisting of 21 day cycles | ||
| − | ==== | + | ====Chemotherapy, VDC portion==== |
| − | *[[Vincristine (Oncovin)]] 2 mg/m<sup>2</sup> IV push once on day 1 (maximum dose of 2 mg) | + | *[[Vincristine (Oncovin)]] as follows: |
| − | **Treat with 50% doses calculated on a m<sup>2</sup> basis for children < 1 year, then consider increasing to 75% and then to 100 % of calculated dose if tolerated | + | **Cycles 1 & 3: 2 mg/m<sup>2</sup> IV push once on day 1 (maximum dose of 2 mg) |
| − | *[[Doxorubicin (Adriamycin)]] 75 mg/m<sup>2</sup> IV infusion over 48 hours once on day 1 | + | ***Treat with 50% doses calculated on a m<sup>2</sup> basis for children < 1 year, then consider increasing to 75% and then to 100 % of calculated dose if tolerated |
| − | **Treat with 50% doses calculated on a m<sup>2</sup> basis for children < 1 year, then consider increasing to 75% and then to 100 % of calculated dose if tolerated | + | *[[Doxorubicin (Adriamycin)]] as follows: |
| − | *[[Cyclophosphamide (Cytoxan)]] 1200 mg/m<sup>2</sup> IV over 1 hour on Days 1 | + | **Cycles 1 & 3: 75 mg/m<sup>2</sup> IV infusion over 48 hours once on day 1 |
| − | **Treat with 50% doses calculated on a m<sup>2</sup> basis for children < 1 year, then consider increasing to 75% and then to 100 % of calculated dose if tolerated | + | ***Treat with 50% doses calculated on a m<sup>2</sup> basis for children < 1 year, then consider increasing to 75% and then to 100 % of calculated dose if tolerated |
| − | *[[Mesna (Mesnex)]] 720 mg/m<sup>2</sup> IV continuous infusion on day 1 | + | *[[Cyclophosphamide (Cytoxan)]] as follows: |
| − | **NOTE: Protocol states that [[Mesna (Mesnex)]] should be dosed as AT LEAST 60% of [[Cyclophosphamide (Cytoxan)]] m<sup>2</sup> | + | **Cycles 1 & 3: 1200 mg/m<sup>2</sup> IV over 1 hour on Days 1 |
| − | **[[Mesna (Mesnex)]] continuous infusion should be started at the same time as the [[Cyclophosphamide (Cytoxan)]] and remain until at least 8 hours after the end of the [[Cyclophosphamide (Cytoxan)]] infusion | + | ***Treat with 50% doses calculated on a m<sup>2</sup> basis for children < 1 year, then consider increasing to 75% and then to 100 % of calculated dose if tolerated |
| − | *[[Filgrastim (Neupogen)]] 5 mcg/kg SC for at least 7 days, or until ANC ≥ 750/μl, beginning on day 2 | + | ====Supportive medications, VDC portion==== |
| − | **ANC ≥ 750/μl on or before day 7 of the cycle is not sufficient for discontinuing G-CSF | + | *[[Mesna (Mesnex)]] as follows: |
| + | **Cycles 1 & 3: 720 mg/m<sup>2</sup> IV continuous infusion on day 1 | ||
| + | ***NOTE: Protocol states that [[Mesna (Mesnex)]] should be dosed as AT LEAST 60% of [[Cyclophosphamide (Cytoxan)]] m<sup>2</sup> | ||
| + | ***[[Mesna (Mesnex)]] continuous infusion should be started at the same time as the [[Cyclophosphamide (Cytoxan)]] and remain until at least 8 hours after the end of the [[Cyclophosphamide (Cytoxan)]] infusion | ||
| + | *[[Filgrastim (Neupogen)]] as follows: | ||
| + | **Cycles 1 & 3: 5 mcg/kg SC for at least 7 days, or until ANC ≥ 750/μl, beginning on day 2 | ||
| + | ***ANC ≥ 750/μl on or before day 7 of the cycle is not sufficient for discontinuing G-CSF | ||
'''21 day cycle''' | '''21 day cycle''' | ||
| − | ==== | + | ====Chemotherapy, IE portion==== |
| − | *[[Ifosfamide (Ifex)]] 1800 mg/m<sup>2</sup> IV infusion over 1 hour once on day 1 to 5 | + | *[[Ifosfamide (Ifex)]] as follows: |
| − | **Treat with 50% doses calculated on a m<sup>2</sup> basis for children < 1 year, then consider increasing to 75% and then to 100 % of calculated dose if tolerated | + | **Cycles 2 & 4: 1800 mg/m<sup>2</sup> IV infusion over 1 hour once on day 1 to 5 |
| − | *[[Etoposide (Vepesid)]] 100 mg/m<sup>2</sup> IV infusion over 1 to 2 hours once on days 1 to 5 | + | ***Treat with 50% doses calculated on a m<sup>2</sup> basis for children < 1 year, then consider increasing to 75% and then to 100 % of calculated dose if tolerated |
| − | **Treat with 50% doses calculated on a m<sup>2</sup> basis for children < 1 year, then consider increasing to 75% and then to 100 % of calculated dose if tolerated | + | *[[Etoposide (Vepesid)]] as follows: |
| − | *[[Mesna (Mesnex)]] 1080 mg/m<sup>2</sup> IV continuous infusion on day 1 | + | **Cycles 2 & 4: 100 mg/m<sup>2</sup> IV infusion over 1 to 2 hours once on days 1 to 5 |
| − | **NOTE: Protocol states that [[Mesna (Mesnex)]] should be dosed as AT LEAST 60% of [[Ifosfamide (Ifex)]] m<sup>2</sup> | + | ***Treat with 50% doses calculated on a m<sup>2</sup> basis for children < 1 year, then consider increasing to 75% and then to 100 % of calculated dose if tolerated |
| − | **[[Mesna (Mesnex)]] continuous infusion should be started at the same time as the [[Ifosfamide (Ifex)]] and remain until at least 8 hours after the end of the [[Ifosfamide (Ifex)]] infusion | + | ====Supportive medications, IE portion==== |
| − | *[[Filgrastim (Neupogen)]] 5 mcg/kg SC for at least 7 days, or until ANC ≥ 750/μl, beginning on day 6 | + | *[[Mesna (Mesnex)]] as follows: |
| − | **ANC ≥ 750/μl on or before day 7 of the cycle is not sufficient for discontinuing G-CSF | + | **Cycles 2 & 4: 1080 mg/m<sup>2</sup> IV continuous infusion on day 1 |
| + | ***NOTE: Protocol states that [[Mesna (Mesnex)]] should be dosed as AT LEAST 60% of [[Ifosfamide (Ifex)]] m<sup>2</sup> | ||
| + | ***[[Mesna (Mesnex)]] continuous infusion should be started at the same time as the [[Ifosfamide (Ifex)]] and remain until at least 8 hours after the end of the [[Ifosfamide (Ifex)]] infusion | ||
| + | *[[Filgrastim (Neupogen)]] as follows: | ||
| + | **Cycles 2 & 4: 5 mcg/kg SC for at least 7 days, or until ANC ≥ 750/μl, beginning on day 6 | ||
| + | ***ANC ≥ 750/μl on or before day 7 of the cycle is not sufficient for discontinuing G-CSF | ||
'''21 day cycle''' | '''21 day cycle''' | ||
| − | == | + | ==COG AEWS0031 Continuation A== |
*At week 13 patients either underwent surgery, received radiation, or both | *At week 13 patients either underwent surgery, received radiation, or both | ||
*Radiation coincided with cycle 5 | *Radiation coincided with cycle 5 | ||
| − | ==== | + | ===Regimen=== |
| + | ====Chemotherapy, VDC portion==== | ||
Cycle 5 begins on week 15 in patients receiving surgery and on week 13 in Regimen A<sub>2</sub> | Cycle 5 begins on week 15 in patients receiving surgery and on week 13 in Regimen A<sub>2</sub> | ||
| − | *[[Vincristine (Oncovin)]] 2 mg/m<sup>2</sup> IV push once on day 1 (maximum dose of 2 mg) | + | *[[Vincristine (Oncovin)]] as follows: |
| − | **Treat with 50% doses calculated on a m<sup>2</sup> basis for children < 1 year, then consider increasing to 75% and then to 100 % of calculated dose if tolerated | + | **Cycle 5 & 9: 2 mg/m<sup>2</sup> IV push once on day 1 (maximum dose of 2 mg) |
| − | *[[Doxorubicin (Adriamycin)]] 75 mg/m<sup>2</sup> IV infusion over 48 hours once on day 1 | + | ***Treat with 50% doses calculated on a m<sup>2</sup> basis for children < 1 year, then consider increasing to 75% and then to 100 % of calculated dose if tolerated |
| − | **Treat with 50% doses calculated on a m<sup>2</sup> basis for children < 1 year, then consider increasing to 75% and then to 100 % of calculated dose if tolerated | + | *[[Doxorubicin (Adriamycin)]] as follows: |
| − | *[[Cyclophosphamide (Cytoxan)]] 1200 mg/m<sup>2</sup> IV over 1 hour on Days 1 | + | **Cycle 5 & 9: 75 mg/m<sup>2</sup> IV infusion over 48 hours once on day 1 |
| − | **Treat with 50% doses calculated on a m<sup>2</sup> basis for children < 1 year, then consider increasing to 75% and then to 100 % of calculated dose if tolerated | + | ***Treat with 50% doses calculated on a m<sup>2</sup> basis for children < 1 year, then consider increasing to 75% and then to 100 % of calculated dose if tolerated |
| − | *[[Mesna (Mesnex)]] 720 mg/m<sup>2</sup> IV continuous infusion on day 1 | + | *[[Cyclophosphamide (Cytoxan)]] as follows: |
| − | **NOTE: Protocol states that [[Mesna (Mesnex)]] should be dosed as AT LEAST 60% of [[Cyclophosphamide (Cytoxan)]] m<sup>2</sup> | + | **Cycle 5 & 9: 1200 mg/m<sup>2</sup> IV over 1 hour on Days 1 |
| − | **[[Mesna (Mesnex)]] continuous infusion should be started at the same time as the [[Cyclophosphamide (Cytoxan)]] and remain until at least 8 hours after the end of the [[Cyclophosphamide (Cytoxan)]] infusion | + | ***Treat with 50% doses calculated on a m<sup>2</sup> basis for children < 1 year, then consider increasing to 75% and then to 100 % of calculated dose if tolerated |
| − | *[[Filgrastim (Neupogen)]] 5 mcg/kg SC for at least 7 days, or until ANC ≥ 750/μl, beginning on day 2 | + | ====Supportive medication, VDC portion==== |
| − | **ANC ≥ 750/μl on or before day 7 of the cycle is not sufficient for discontinuing G-CSF | + | *[[Mesna (Mesnex)]] as follows: |
| + | **Cycle 5 & 9: 720 mg/m<sup>2</sup> IV continuous infusion on day 1 | ||
| + | ***NOTE: Protocol states that [[Mesna (Mesnex)]] should be dosed as AT LEAST 60% of [[Cyclophosphamide (Cytoxan)]] m<sup>2</sup> | ||
| + | ***[[Mesna (Mesnex)]] continuous infusion should be started at the same time as the [[Cyclophosphamide (Cytoxan)]] and remain until at least 8 hours after the end of the [[Cyclophosphamide (Cytoxan)]] infusion | ||
| + | *[[Filgrastim (Neupogen)]] as follows: | ||
| + | **Cycle 5 & 9: 5 mcg/kg SC for at least 7 days, or until ANC ≥ 750/μl, beginning on day 2 | ||
| + | ***ANC ≥ 750/μl on or before day 7 of the cycle is not sufficient for discontinuing G-CSF | ||
'''21 day cycle''' | '''21 day cycle''' | ||
| − | ==== | + | ====Chemotherapy, IE portion==== |
| − | *[[Ifosfamide (Ifex)]] 1800 mg/m<sup>2</sup> IV infusion over 1 hour once on day 1 to 5 | + | *[[Ifosfamide (Ifex)]] as follows: |
| − | **Treat with 50% doses calculated on a m<sup>2</sup> basis for children < 1 year, then consider increasing to 75% and then to 100 % of calculated dose if tolerated | + | **Cycle 6, 8, 10, 12, & 14: 1800 mg/m<sup>2</sup> IV infusion over 1 hour once on day 1 to 5 |
| − | *[[Etoposide (Vepesid)]] 100 mg/m<sup>2</sup> IV infusion over 1 to 2 hours once on days 1 to 5 | + | ***Treat with 50% doses calculated on a m<sup>2</sup> basis for children < 1 year, then consider increasing to 75% and then to 100 % of calculated dose if tolerated |
| − | **Treat with 50% doses calculated on a m<sup>2</sup> basis for children < 1 year, then consider increasing to 75% and then to 100 % of calculated dose if tolerated | + | *[[Etoposide (Vepesid)]] as follows: |
| − | *[[Mesna (Mesnex)]] 1080 mg/m<sup>2</sup> IV continuous infusion on day 1 | + | **Cycle 6, 8, 10, 12, & 14: 100 mg/m<sup>2</sup> IV infusion over 1 to 2 hours once on days 1 to 5 |
| − | **NOTE: Protocol states that [[Mesna (Mesnex)]] should be dosed as AT LEAST 60% of [[Ifosfamide (Ifex)]] m<sup>2</sup> | + | ***Treat with 50% doses calculated on a m<sup>2</sup> basis for children < 1 year, then consider increasing to 75% and then to 100 % of calculated dose if tolerated |
| − | **[[Mesna (Mesnex)]] continuous infusion should be started at the same time as the [[Ifosfamide (Ifex)]] and remain until at least 8 hours after the end of the [[Ifosfamide (Ifex)]] infusion | + | ====Supportive medications, IE portion==== |
| − | *[[Filgrastim (Neupogen)]] 5 mcg/kg SC for at least 7 days, or until ANC ≥ 750/μl, beginning on day 6 | + | *[[Mesna (Mesnex)]] as follows: |
| − | **ANC ≥ 750/μl on or before day 7 of the cycle is not sufficient for discontinuing G-CSF | + | **Cycle 6, 8, 10, 12, & 14: 1080 mg/m<sup>2</sup> IV continuous infusion on day 1 |
| + | ***NOTE: Protocol states that [[Mesna (Mesnex)]] should be dosed as AT LEAST 60% of [[Ifosfamide (Ifex)]] m<sup>2</sup> | ||
| + | ***[[Mesna (Mesnex)]] continuous infusion should be started at the same time as the [[Ifosfamide (Ifex)]] and remain until at least 8 hours after the end of the [[Ifosfamide (Ifex)]] infusion | ||
| + | *[[Filgrastim (Neupogen)]] as follows: | ||
| + | **Cycle 6, 8, 10, 12, & 14: 5 mcg/kg SC for at least 7 days, or until ANC ≥ 750/μl, beginning on day 6 | ||
| + | ***ANC ≥ 750/μl on or before day 7 of the cycle is not sufficient for discontinuing G-CSF | ||
'''21 day cycle''' | '''21 day cycle''' | ||
| − | ==== | + | ====Chemotherapy, VDC portion Regimen A<sub>1</sub> (Surgery Only)==== |
| − | *[[Vincristine (Oncovin)]] 2 mg/m<sup>2</sup> IV push once on day 1 (maximum dose of 2 mg) | + | *[[Vincristine (Oncovin)]] as follows: |
| − | **Treat with 50% doses calculated on a m<sup>2</sup> basis for children < 1 year, then consider increasing to 75% and then to 100 % of calculated dose if tolerated | + | **Cycle 7: 2 mg/m<sup>2</sup> IV push once on day 1 (maximum dose of 2 mg) |
| − | *[[Doxorubicin (Adriamycin)]] 75 mg/m<sup>2</sup> IV infusion over 48 hours once on day 1 | + | ***Treat with 50% doses calculated on a m<sup>2</sup> basis for children < 1 year, then consider increasing to 75% and then to 100 % of calculated dose if tolerated |
| − | **Treat with 50% doses calculated on a m<sup>2</sup> basis for children < 1 year, then consider increasing to 75% and then to 100 % of calculated dose if tolerated | + | *[[Doxorubicin (Adriamycin)]] as follows: |
| − | *[[Cyclophosphamide (Cytoxan)]] 1200 mg/m<sup>2</sup> IV over 1 hour on Days 1 | + | **Cycle 7: 75 mg/m<sup>2</sup> IV infusion over 48 hours once on day 1 |
| − | **Treat with 50% doses calculated on a m<sup>2</sup> basis for children < 1 year, then consider increasing to 75% and then to 100 % of calculated dose if tolerated | + | ***Treat with 50% doses calculated on a m<sup>2</sup> basis for children < 1 year, then consider increasing to 75% and then to 100 % of calculated dose if tolerated |
| − | *[[Mesna (Mesnex)]] 720 mg/m<sup>2</sup> IV continuous infusion on day 1 | + | *[[Cyclophosphamide (Cytoxan)]] as follows: |
| − | **NOTE: Protocol states that [[Mesna (Mesnex)]] should be dosed as AT LEAST 60% of [[Cyclophosphamide (Cytoxan)]] m<sup>2</sup> | + | **Cycle 7: 1200 mg/m<sup>2</sup> IV over 1 hour on Days 1 |
| − | **[[Mesna (Mesnex)]] continuous infusion should be started at the same time as the [[Cyclophosphamide (Cytoxan)]] and remain until at least 8 hours after the end of the [[Cyclophosphamide (Cytoxan)]] infusion | + | ***Treat with 50% doses calculated on a m<sup>2</sup> basis for children < 1 year, then consider increasing to 75% and then to 100 % of calculated dose if tolerated |
| − | *[[Filgrastim (Neupogen)]] 5 mcg/kg SC for at least 7 days, or until ANC ≥ 750/μl, beginning on day 2 | + | ====Supportive therapy, VDC portion Regimen A<sub>1</sub> (Surgery Only)==== |
| + | *[[Mesna (Mesnex)]] as follows: | ||
| + | **Cycle 7: 720 mg/m<sup>2</sup> IV continuous infusion on day 1 | ||
| + | ***NOTE: Protocol states that [[Mesna (Mesnex)]] should be dosed as AT LEAST 60% of [[Cyclophosphamide (Cytoxan)]] m<sup>2</sup> | ||
| + | ***[[Mesna (Mesnex)]] continuous infusion should be started at the same time as the [[Cyclophosphamide (Cytoxan)]] and remain until at least 8 hours after the end of the [[Cyclophosphamide (Cytoxan)]] infusion | ||
| + | *[[Filgrastim (Neupogen)]] as follows: | ||
| + | **Cycle 7: 5 mcg/kg SC for at least 7 days, or until ANC ≥ 750/μl, beginning on day 2 | ||
**ANC ≥ 750/μl on or before day 7 of the cycle is not sufficient for discontinuing G-CSF | **ANC ≥ 750/μl on or before day 7 of the cycle is not sufficient for discontinuing G-CSF | ||
'''21 day cycle''' | '''21 day cycle''' | ||
| − | ==== | + | ====Chemotherapy, VC portion Regimen A<sub>2</sub> & A<sub>3</sub> (Radiation w/ or w/o Surgery)==== |
| − | *[[Vincristine (Oncovin)]] 2 mg/m<sup>2</sup> IV push once on day 1 (maximum dose of 2 mg) | + | *[[Vincristine (Oncovin)]] as follows: |
| − | **Treat with 50% doses calculated on a m<sup>2</sup> basis for children < 1 year, then consider increasing to 75% and then to 100 % of calculated dose if tolerated | + | **Cycle 7: 2 mg/m<sup>2</sup> IV push once on day 1 (maximum dose of 2 mg) |
| − | *[[Cyclophosphamide (Cytoxan)]] 1200 mg/m<sup>2</sup> IV over 1 hour on Days 1 | + | ***Treat with 50% doses calculated on a m<sup>2</sup> basis for children < 1 year, then consider increasing to 75% and then to 100 % of calculated dose if tolerated |
| − | **Treat with 50% doses calculated on a m<sup>2</sup> basis for children < 1 year, then consider increasing to 75% and then to 100 % of calculated dose if tolerated | + | *[[Cyclophosphamide (Cytoxan)]] as follows: |
| − | *[[Mesna (Mesnex)]] 720 mg/m<sup>2</sup> IV continuous infusion on day 1 | + | **Cycle 7: 1200 mg/m<sup>2</sup> IV over 1 hour on Days 1 |
| − | **NOTE: Protocol states that [[Mesna (Mesnex)]] should be dosed as AT LEAST 60% of [[Cyclophosphamide (Cytoxan)]] m<sup>2</sup> | + | ***Treat with 50% doses calculated on a m<sup>2</sup> basis for children < 1 year, then consider increasing to 75% and then to 100 % of calculated dose if tolerated |
| − | **[[Mesna (Mesnex)]] continuous infusion should be started at the same time as the [[Cyclophosphamide (Cytoxan)]] and remain until at least 8 hours after the end of the [[Cyclophosphamide (Cytoxan)]] infusion | + | ====Supportive medications, VC portion Regimen A<sub>2</sub> & A<sub>3</sub> (Radiation w/ or w/o Surgery)==== |
| − | *[[Filgrastim (Neupogen)]] 5 mcg/kg SC for at least 7 days, or until ANC ≥ 750/μl, beginning on day 2 | + | *[[Mesna (Mesnex)]] as follows: |
| + | **Cycle 7: 720 mg/m<sup>2</sup> IV continuous infusion on day 1 | ||
| + | ***NOTE: Protocol states that [[Mesna (Mesnex)]] should be dosed as AT LEAST 60% of [[Cyclophosphamide (Cytoxan)]] m<sup>2</sup> | ||
| + | ***[[Mesna (Mesnex)]] continuous infusion should be started at the same time as the [[Cyclophosphamide (Cytoxan)]] and remain until at least 8 hours after the end of the [[Cyclophosphamide (Cytoxan)]] infusion | ||
| + | *[[Filgrastim (Neupogen)]] as follows: | ||
| + | **Cycle 7: 5 mcg/kg SC for at least 7 days, or until ANC ≥ 750/μl, beginning on day 2 | ||
**ANC ≥ 750/μl on or before day 7 of the cycle is not sufficient for discontinuing G-CSF | **ANC ≥ 750/μl on or before day 7 of the cycle is not sufficient for discontinuing G-CSF | ||
'''21 day cycle''' | '''21 day cycle''' | ||
| − | ==== | + | ====Chemotherapy, VC portion Regimen A<sub>1</sub> (Surgery Only)==== |
| − | *[[Vincristine (Oncovin)]] 2 mg/m<sup>2</sup> IV push once on day 1 (maximum dose of 2 mg) | + | *[[Vincristine (Oncovin)]] as follows: |
| − | **Treat with 50% doses calculated on a m<sup>2</sup> basis for children < 1 year, then consider increasing to 75% and then to 100 % of calculated dose if tolerated | + | **Cycle 11: 2 mg/m<sup>2</sup> IV push once on day 1 (maximum dose of 2 mg) |
| − | *[[Cyclophosphamide (Cytoxan)]] 1200 mg/m<sup>2</sup> IV over 1 hour on Days 1 | + | ***Treat with 50% doses calculated on a m<sup>2</sup> basis for children < 1 year, then consider increasing to 75% and then to 100 % of calculated dose if tolerated |
| − | **Treat with 50% doses calculated on a m<sup>2</sup> basis for children < 1 year, then consider increasing to 75% and then to 100 % of calculated dose if tolerated | + | *[[Cyclophosphamide (Cytoxan)]] as follows: |
| − | *[[Mesna (Mesnex)]] 720 mg/m<sup>2</sup> IV continuous infusion on day 1 | + | **Cycle 11: 1200 mg/m<sup>2</sup> IV over 1 hour on Days 1 |
| − | **NOTE: Protocol states that [[Mesna (Mesnex)]] should be dosed as AT LEAST 60% of [[Cyclophosphamide (Cytoxan)]] m<sup>2</sup> | + | ***Treat with 50% doses calculated on a m<sup>2</sup> basis for children < 1 year, then consider increasing to 75% and then to 100 % of calculated dose if tolerated |
| − | **[[Mesna (Mesnex)]] continuous infusion should be started at the same time as the [[Cyclophosphamide (Cytoxan)]] and remain until at least 8 hours after the end of the [[Cyclophosphamide (Cytoxan)]] infusion | + | ====Supportive medications, VC portion Regimen A<sub>1</sub> (Surgery Only)==== |
| − | *[[Filgrastim (Neupogen)]] 5 mcg/kg SC for at least 7 days, or until ANC ≥ 750/μl, beginning on day 2 | + | *[[Mesna (Mesnex)]] as follows: |
| − | **ANC ≥ 750/μl on or before day 7 of the cycle is not sufficient for discontinuing G-CSF | + | **Cycle 11: 720 mg/m<sup>2</sup> IV continuous infusion on day 1 |
| + | ***NOTE: Protocol states that [[Mesna (Mesnex)]] should be dosed as AT LEAST 60% of [[Cyclophosphamide (Cytoxan)]] m<sup>2</sup> | ||
| + | ***[[Mesna (Mesnex)]] continuous infusion should be started at the same time as the [[Cyclophosphamide (Cytoxan)]] and remain until at least 8 hours after the end of the [[Cyclophosphamide (Cytoxan)]] infusion | ||
| + | *[[Filgrastim (Neupogen)]] as follows: | ||
| + | **Cycle 11: 5 mcg/kg SC for at least 7 days, or until ANC ≥ 750/μl, beginning on day 2 | ||
| + | ***ANC ≥ 750/μl on or before day 7 of the cycle is not sufficient for discontinuing G-CSF | ||
'''21 day cycle''' | '''21 day cycle''' | ||
| − | ==== | + | ====Chemotherapy, VDC portion Regimen A<sub>2</sub> & A<sub>3</sub> (Radiation w/ or w/o Surgery)==== |
| − | *[[Vincristine (Oncovin)]] 2 mg/m<sup>2</sup> IV push once on day 1 (maximum dose of 2 mg) | + | *[[Vincristine (Oncovin)]] as follows: |
| − | **Treat with 50% doses calculated on a m<sup>2</sup> basis for children < 1 year, then consider increasing to 75% and then to 100 % of calculated dose if tolerated | + | **Cycle 11: 2 mg/m<sup>2</sup> IV push once on day 1 (maximum dose of 2 mg) |
| − | *[[Doxorubicin (Adriamycin)]] 75 mg/m<sup>2</sup> IV infusion over 48 hours once on day 1 | + | ***Treat with 50% doses calculated on a m<sup>2</sup> basis for children < 1 year, then consider increasing to 75% and then to 100 % of calculated dose if tolerated |
| − | **Treat with 50% doses calculated on a m<sup>2</sup> basis for children < 1 year, then consider increasing to 75% and then to 100 % of calculated dose if tolerated | + | *[[Doxorubicin (Adriamycin)]] as follows: |
| − | *[[Cyclophosphamide (Cytoxan)]] 1200 mg/m<sup>2</sup> IV over 1 hour on Days 1 | + | **Cycle 11: 75 mg/m<sup>2</sup> IV infusion over 48 hours once on day 1 |
| − | **Treat with 50% doses calculated on a m<sup>2</sup> basis for children < 1 year, then consider increasing to 75% and then to 100 % of calculated dose if tolerated | + | ***Treat with 50% doses calculated on a m<sup>2</sup> basis for children < 1 year, then consider increasing to 75% and then to 100 % of calculated dose if tolerated |
| − | *[[Mesna (Mesnex)]] 720 mg/m<sup>2</sup> IV continuous infusion on day 1 | + | *[[Cyclophosphamide (Cytoxan)]] as follows: |
| − | **NOTE: Protocol states that [[Mesna (Mesnex)]] should be dosed as AT LEAST 60% of [[Cyclophosphamide (Cytoxan)]] m<sup>2</sup> | + | **Cycle 11: 1200 mg/m<sup>2</sup> IV over 1 hour on Days 1 |
| − | **[[Mesna (Mesnex)]] continuous infusion should be started at the same time as the [[Cyclophosphamide (Cytoxan)]] and remain until at least 8 hours after the end of the [[Cyclophosphamide (Cytoxan)]] infusion | + | ***Treat with 50% doses calculated on a m<sup>2</sup> basis for children < 1 year, then consider increasing to 75% and then to 100 % of calculated dose if tolerated |
| − | *[[Filgrastim (Neupogen)]] 5 mcg/kg SC for at least 7 days, or until ANC ≥ 750/μl, beginning on day 2 | + | ====Supportive medications, VDC portion Regimen A<sub>2</sub> & A<sub>3</sub> (Radiation w/ or w/o Surgery)==== |
| + | *[[Mesna (Mesnex)]] as follows: | ||
| + | **Cycle 11: 720 mg/m<sup>2</sup> IV continuous infusion on day 1 | ||
| + | ***NOTE: Protocol states that [[Mesna (Mesnex)]] should be dosed as AT LEAST 60% of [[Cyclophosphamide (Cytoxan)]] m<sup>2</sup> | ||
| + | ***[[Mesna (Mesnex)]] continuous infusion should be started at the same time as the [[Cyclophosphamide (Cytoxan)]] and remain until at least 8 hours after the end of the [[Cyclophosphamide (Cytoxan)]] infusion | ||
| + | *[[Filgrastim (Neupogen)]] as follows: | ||
| + | **Cycle 11: 5 mcg/kg SC for at least 7 days, or until ANC ≥ 750/μl, beginning on day 2 | ||
**ANC ≥ 750/μl on or before day 7 of the cycle is not sufficient for discontinuing G-CSF | **ANC ≥ 750/μl on or before day 7 of the cycle is not sufficient for discontinuing G-CSF | ||
'''21 day cycle''' | '''21 day cycle''' | ||
| − | ==== | + | ====Chemotherapy, VC portion==== |
| − | *[[Vincristine (Oncovin)]] 2 mg/m<sup>2</sup> IV push once on day 1 (maximum dose of 2 mg) | + | *[[Vincristine (Oncovin)]] as follows: |
| − | **Treat with 50% doses calculated on a m<sup>2</sup> basis for children < 1 year, then consider increasing to 75% and then to 100 % of calculated dose if tolerated | + | **Cycle 13: 2 mg/m<sup>2</sup> IV push once on day 1 (maximum dose of 2 mg) |
| − | *[[Cyclophosphamide (Cytoxan)]] 1200 mg/m<sup>2</sup> IV over 1 hour on Days 1 | + | ***Treat with 50% doses calculated on a m<sup>2</sup> basis for children < 1 year, then consider increasing to 75% and then to 100 % of calculated dose if tolerated |
| − | **Treat with 50% doses calculated on a m<sup>2</sup> basis for children < 1 year, then consider increasing to 75% and then to 100 % of calculated dose if tolerated | + | *[[Cyclophosphamide (Cytoxan)]] as follows: |
| − | *[[Mesna (Mesnex)]] 720 mg/m<sup>2</sup> IV continuous infusion on day 1 | + | **Cycle 13: 1200 mg/m<sup>2</sup> IV over 1 hour on Days 1 |
| − | **NOTE: Protocol states that [[Mesna (Mesnex)]] should be dosed as AT LEAST 60% of [[Cyclophosphamide (Cytoxan)]] m<sup>2</sup> | + | ***Treat with 50% doses calculated on a m<sup>2</sup> basis for children < 1 year, then consider increasing to 75% and then to 100 % of calculated dose if tolerated |
| − | **[[Mesna (Mesnex)]] continuous infusion should be started at the same time as the [[Cyclophosphamide (Cytoxan)]] and remain until at least 8 hours after the end of the [[Cyclophosphamide (Cytoxan)]] infusion | + | ====Supportive medications, VC portion==== |
| − | *[[Filgrastim (Neupogen)]] 5 mcg/kg SC for at least 7 days, or until ANC ≥ 750/μl, beginning on day 2 | + | *[[Mesna (Mesnex)]] as follows: |
| − | **ANC ≥ 750/μl on or before day 7 of the cycle is not sufficient for discontinuing G-CSF | + | **Cycle 13: 720 mg/m<sup>2</sup> IV continuous infusion on day 1 |
| + | ***NOTE: Protocol states that [[Mesna (Mesnex)]] should be dosed as AT LEAST 60% of [[Cyclophosphamide (Cytoxan)]] m<sup>2</sup> | ||
| + | ***[[Mesna (Mesnex)]] continuous infusion should be started at the same time as the [[Cyclophosphamide (Cytoxan)]] and remain until at least 8 hours after the end of the [[Cyclophosphamide (Cytoxan)]] infusion | ||
| + | *[[Filgrastim (Neupogen)]] as follows: | ||
| + | **Cycle 13: 5 mcg/kg SC for at least 7 days, or until ANC ≥ 750/μl, beginning on day 2 | ||
| + | ***ANC ≥ 750/μl on or before day 7 of the cycle is not sufficient for discontinuing G-CSF | ||
'''21 day cycle''' | '''21 day cycle''' | ||
| − | == | + | ==COG AEWS0031 Induction B== |
*Regimen B is a consolidated regimen consisting of 14 day cycles | *Regimen B is a consolidated regimen consisting of 14 day cycles | ||
| − | ==== | + | ===Regimen=== |
| − | *[[Vincristine (Oncovin)]] 2 mg/m<sup>2</sup> IV push once on day 1 (maximum dose of 2 mg) | + | |
| − | **Treat with 50% doses calculated on a m<sup>2</sup> basis for children < 1 year, then consider increasing to 75% and then to 100 % of calculated dose if tolerated | + | ====Chemotherapy, VDC portion==== |
| − | *[[Doxorubicin (Adriamycin)]] 75 mg/m<sup>2</sup> IV infusion over 48 hours once on day 1 | + | *[[Vincristine (Oncovin)]] as follows: |
| − | **Treat with 50% doses calculated on a m<sup>2</sup> basis for children < 1 year, then consider increasing to 75% and then to 100 % of calculated dose if tolerated | + | **Cycles 1, 3, & 5: 2 mg/m<sup>2</sup> IV push once on day 1 (maximum dose of 2 mg) |
| − | *[[Cyclophosphamide (Cytoxan)]] 1200 mg/m<sup>2</sup> IV over 1 hour on Days 1 | + | ***Treat with 50% doses calculated on a m<sup>2</sup> basis for children < 1 year, then consider increasing to 75% and then to 100 % of calculated dose if tolerated |
| − | **Treat with 50% doses calculated on a m<sup>2</sup> basis for children < 1 year, then consider increasing to 75% and then to 100 % of calculated dose if tolerated | + | *[[Doxorubicin (Adriamycin)]] as follows: |
| − | *[[Mesna (Mesnex)]] 720 mg/m<sup>2</sup> IV continuous infusion on day 1 | + | **Cycles 1, 3, & 5: 75 mg/m<sup>2</sup> IV infusion over 48 hours once on day 1 |
| − | **NOTE: Protocol states that [[Mesna (Mesnex)]] should be dosed as AT LEAST 60% of [[Cyclophosphamide (Cytoxan)]] m<sup>2</sup> | + | ***Treat with 50% doses calculated on a m<sup>2</sup> basis for children < 1 year, then consider increasing to 75% and then to 100 % of calculated dose if tolerated |
| − | **[[Mesna (Mesnex)]] continuous infusion should be started at the same time as the [[Cyclophosphamide (Cytoxan)]] and remain until at least 8 hours after the end of the [[Cyclophosphamide (Cytoxan)]] infusion | + | *[[Cyclophosphamide (Cytoxan)]] as follows: |
| − | *[[Filgrastim (Neupogen)]] 5 mcg/kg SC for at least 7 days, or until ANC ≥ 750/μl, beginning on day 2 | + | **Cycles 1, 3, & 5: 1200 mg/m<sup>2</sup> IV over 1 hour on Days 1 |
| − | **ANC ≥ 750/μl on or before day 7 of the cycle is not sufficient for discontinuing G-CSF | + | ***Treat with 50% doses calculated on a m<sup>2</sup> basis for children < 1 year, then consider increasing to 75% and then to 100 % of calculated dose if tolerated |
| + | ====Supportive medications, VDC portion==== | ||
| + | *[[Mesna (Mesnex)]] as follows: | ||
| + | **Cycles 1, 3, & 5: 720 mg/m<sup>2</sup> IV continuous infusion on day 1 | ||
| + | ***NOTE: Protocol states that [[Mesna (Mesnex)]] should be dosed as AT LEAST 60% of [[Cyclophosphamide (Cytoxan)]] m<sup>2</sup> | ||
| + | ***[[Mesna (Mesnex)]] continuous infusion should be started at the same time as the [[Cyclophosphamide (Cytoxan)]] and remain until at least 8 hours after the end of the [[Cyclophosphamide (Cytoxan)]] infusion | ||
| + | *[[Filgrastim (Neupogen)]] as follows: | ||
| + | **Cycles 1, 3, & 5: 5 mcg/kg SC for at least 7 days, or until ANC ≥ 750/μl, beginning on day 2 | ||
| + | ***ANC ≥ 750/μl on or before day 7 of the cycle is not sufficient for discontinuing G-CSF | ||
'''14 day cycle''' | '''14 day cycle''' | ||
| − | ==== | + | ====Chemotherapy, IE portion==== |
| − | *[[Ifosfamide (Ifex)]] 1800 mg/m<sup>2</sup> IV infusion over 1 hour once on day 1 to 5 | + | *[[Ifosfamide (Ifex)]] as follows: |
| − | **Treat with 50% doses calculated on a m<sup>2</sup> basis for children < 1 year, then consider increasing to 75% and then to 100 % of calculated dose if tolerated | + | **Cycle 2, 4, & 6: 1800 mg/m<sup>2</sup> IV infusion over 1 hour once on day 1 to 5 |
| − | *[[Etoposide (Vepesid)]] 100 mg/m<sup>2</sup> IV infusion over 1 to 2 hours once on days 1 to 5 | + | ***Treat with 50% doses calculated on a m<sup>2</sup> basis for children < 1 year, then consider increasing to 75% and then to 100 % of calculated dose if tolerated |
| − | **Treat with 50% doses calculated on a m<sup>2</sup> basis for children < 1 year, then consider increasing to 75% and then to 100 % of calculated dose if tolerated | + | *[[Etoposide (Vepesid)]] as follows: |
| − | *[[Mesna (Mesnex)]] 1080 mg/m<sup>2</sup> IV continuous infusion on day 1 | + | **Cycle 2, 4, & 6: 100 mg/m<sup>2</sup> IV infusion over 1 to 2 hours once on days 1 to 5 |
| − | **NOTE: Protocol states that [[Mesna (Mesnex)]] should be dosed as AT LEAST 60% of [[Ifosfamide (Ifex)]] m<sup>2</sup> | + | ***Treat with 50% doses calculated on a m<sup>2</sup> basis for children < 1 year, then consider increasing to 75% and then to 100 % of calculated dose if tolerated |
| − | **[[Mesna (Mesnex)]] continuous infusion should be started at the same time as the [[Ifosfamide (Ifex)]] and remain until at least 8 hours after the end of the [[Ifosfamide (Ifex)]] infusion | + | ====Supportive medications, IE portion==== |
| − | *[[Filgrastim (Neupogen)]] 5 mcg/kg SC for at least 7 days, or until ANC ≥ 750/μl, beginning on day 6 | + | *[[Mesna (Mesnex)]] as follows: |
| − | **ANC ≥ 750/μl on or before day 7 of the cycle is not sufficient for discontinuing G-CSF | + | **Cycle 2, 4, & 6: 1080 mg/m<sup>2</sup> IV continuous infusion on day 1 |
| + | ***NOTE: Protocol states that [[Mesna (Mesnex)]] should be dosed as AT LEAST 60% of [[Ifosfamide (Ifex)]] m<sup>2</sup> | ||
| + | ***[[Mesna (Mesnex)]] continuous infusion should be started at the same time as the [[Ifosfamide (Ifex)]] and remain until at least 8 hours after the end of the [[Ifosfamide (Ifex)]] infusion | ||
| + | *[[Filgrastim (Neupogen)]] as follows: | ||
| + | **Cycle 2, 4, & 6: 5 mcg/kg SC for at least 7 days, or until ANC ≥ 750/μl, beginning on day 6 | ||
| + | ***ANC ≥ 750/μl on or before day 7 of the cycle is not sufficient for discontinuing G-CSF | ||
'''14 day cycle''' | '''14 day cycle''' | ||
| − | == | + | ==COG AEWS0031 Continuation B== |
*At week 13 patients either underwent surgery, received radiation, or both | *At week 13 patients either underwent surgery, received radiation, or both | ||
*Radiation coincided with cycle 7 | *Radiation coincided with cycle 7 | ||
| − | ==== | + | ===Regimen=== |
| + | |||
| + | ====Chemotherapy, VDC portion==== | ||
Cycle 7 begins on week 15 in patients receiving surgery and on week 13 in Regimen B<sub>2</sub> | Cycle 7 begins on week 15 in patients receiving surgery and on week 13 in Regimen B<sub>2</sub> | ||
| − | *[[Vincristine (Oncovin)]] 2 mg/m<sup>2</sup> IV push once on day 1 (maximum dose of 2 mg) | + | *[[Vincristine (Oncovin)]] as follows: |
| − | **Treat with 50% doses calculated on a m<sup>2</sup> basis for children < 1 year, then consider increasing to 75% and then to 100 % of calculated dose if tolerated | + | **Cycle 7: 2 mg/m<sup>2</sup> IV push once on day 1 (maximum dose of 2 mg) |
| − | *[[Doxorubicin (Adriamycin)]] 75 mg/m<sup>2</sup> IV infusion over 48 hours once on day 1 | + | ***Treat with 50% doses calculated on a m<sup>2</sup> basis for children < 1 year, then consider increasing to 75% and then to 100 % of calculated dose if tolerated |
| − | **Treat with 50% doses calculated on a m<sup>2</sup> basis for children < 1 year, then consider increasing to 75% and then to 100 % of calculated dose if tolerated | + | *[[Doxorubicin (Adriamycin)]] as follows: |
| − | *[[Cyclophosphamide (Cytoxan)]] 1200 mg/m<sup>2</sup> IV over 1 hour on Days 1 | + | **Cycle 7: 75 mg/m<sup>2</sup> IV infusion over 48 hours once on day 1 |
| − | **Treat with 50% doses calculated on a m<sup>2</sup> basis for children < 1 year, then consider increasing to 75% and then to 100 % of calculated dose if tolerated | + | ***Treat with 50% doses calculated on a m<sup>2</sup> basis for children < 1 year, then consider increasing to 75% and then to 100 % of calculated dose if tolerated |
| − | *[[Mesna (Mesnex)]] 720 mg/m<sup>2</sup> IV continuous infusion on day 1 | + | *[[Cyclophosphamide (Cytoxan)]] as follows: |
| − | **NOTE: Protocol states that [[Mesna (Mesnex)]] should be dosed as AT LEAST 60% of [[Cyclophosphamide (Cytoxan)]] m<sup>2</sup> | + | **Cycle 7: 1200 mg/m<sup>2</sup> IV over 1 hour on Days 1 |
| − | **[[Mesna (Mesnex)]] continuous infusion should be started at the same time as the [[Cyclophosphamide (Cytoxan)]] and remain until at least 8 hours after the end of the [[Cyclophosphamide (Cytoxan)]] infusion | + | ***Treat with 50% doses calculated on a m<sup>2</sup> basis for children < 1 year, then consider increasing to 75% and then to 100 % of calculated dose if tolerated |
| − | *[[Filgrastim (Neupogen)]] 5 mcg/kg SC for at least 7 days, or until ANC ≥ 750/μl, beginning on day 2 | + | ====Supportive medications, VDC portion==== |
| − | **ANC ≥ 750/μl on or before day 7 of the cycle is not sufficient for discontinuing G-CSF | + | *[[Mesna (Mesnex)]] as follows: |
| + | **Cycle 7: 720 mg/m<sup>2</sup> IV continuous infusion on day 1 | ||
| + | ***NOTE: Protocol states that [[Mesna (Mesnex)]] should be dosed as AT LEAST 60% of [[Cyclophosphamide (Cytoxan)]] m<sup>2</sup> | ||
| + | ***[[Mesna (Mesnex)]] continuous infusion should be started at the same time as the [[Cyclophosphamide (Cytoxan)]] and remain until at least 8 hours after the end of the [[Cyclophosphamide (Cytoxan)]] infusion | ||
| + | *[[Filgrastim (Neupogen)]] as follows: | ||
| + | **Cycle 7: 5 mcg/kg SC for at least 7 days, or until ANC ≥ 750/μl, beginning on day 2 | ||
| + | ***ANC ≥ 750/μl on or before day 7 of the cycle is not sufficient for discontinuing G-CSF | ||
'''14 day cycle''' | '''14 day cycle''' | ||
| − | ==== | + | ====Chemotherapy, IE portion==== |
| − | *[[Ifosfamide (Ifex)]] 1800 mg/m<sup>2</sup> IV infusion over 1 hour once on day 1 to 5 | + | *[[Ifosfamide (Ifex)]] as follows: |
| − | **Treat with 50% doses calculated on a m<sup>2</sup> basis for children < 1 year, then consider increasing to 75% and then to 100 % of calculated dose if tolerated | + | **Cycle 8, 10, 12, & 14: 1800 mg/m<sup>2</sup> IV infusion over 1 hour once on day 1 to 5 |
| − | *[[Etoposide (Vepesid)]] 100 mg/m<sup>2</sup> IV infusion over 1 to 2 hours once on days 1 to 5 | + | ***Treat with 50% doses calculated on a m<sup>2</sup> basis for children < 1 year, then consider increasing to 75% and then to 100 % of calculated dose if tolerated |
| − | **Treat with 50% doses calculated on a m<sup>2</sup> basis for children < 1 year, then consider increasing to 75% and then to 100 % of calculated dose if tolerated | + | *[[Etoposide (Vepesid)]] as follows: |
| − | *[[Mesna (Mesnex)]] 1080 mg/m<sup>2</sup> IV continuous infusion on day 1 | + | **Cycle 8, 10, 12, & 14: 100 mg/m<sup>2</sup> IV infusion over 1 to 2 hours once on days 1 to 5 |
| − | **NOTE: Protocol states that [[Mesna (Mesnex)]] should be dosed as AT LEAST 60% of [[Ifosfamide (Ifex)]] m<sup>2</sup> | + | ***Treat with 50% doses calculated on a m<sup>2</sup> basis for children < 1 year, then consider increasing to 75% and then to 100 % of calculated dose if tolerated |
| − | **[[Mesna (Mesnex)]] continuous infusion should be started at the same time as the [[Ifosfamide (Ifex)]] and remain until at least 8 hours after the end of the [[Ifosfamide (Ifex)]] infusion | + | ====Supportive medications, IE portion==== |
| − | *[[Filgrastim (Neupogen)]] 5 mcg/kg SC for at least 7 days, or until ANC ≥ 750/μl, beginning on day 6 | + | *[[Mesna (Mesnex)]] as follows: |
| − | **ANC ≥ 750/μl on or before day 7 of the cycle is not sufficient for discontinuing G-CSF | + | **Cycle 8, 10, 12, & 14: 1080 mg/m<sup>2</sup> IV continuous infusion on day 1 |
| + | ***NOTE: Protocol states that [[Mesna (Mesnex)]] should be dosed as AT LEAST 60% of [[Ifosfamide (Ifex)]] m<sup>2</sup> | ||
| + | ***[[Mesna (Mesnex)]] continuous infusion should be started at the same time as the [[Ifosfamide (Ifex)]] and remain until at least 8 hours after the end of the [[Ifosfamide (Ifex)]] infusion | ||
| + | *[[Filgrastim (Neupogen)]] as follows: | ||
| + | **Cycle 8, 10, 12, & 14: 5 mcg/kg SC for at least 7 days, or until ANC ≥ 750/μl, beginning on day 6 | ||
| + | ***ANC ≥ 750/μl on or before day 7 of the cycle is not sufficient for discontinuing G-CSF | ||
'''14 day cycle''' | '''14 day cycle''' | ||
| − | ==== | + | |
| − | *[[Vincristine (Oncovin)]] 2 mg/m<sup>2</sup> IV push once on day 1 (maximum dose of 2 mg) | + | ====Chemotherapy, VDC portion Regimen B<sub>1</sub> (Surgery Only)==== |
| − | **Treat with 50% doses calculated on a m<sup>2</sup> basis for children < 1 year, then consider increasing to 75% and then to 100 % of calculated dose if tolerated | + | *[[Vincristine (Oncovin)]] as follows: |
| − | *[[Doxorubicin (Adriamycin)]] 75 mg/m<sup>2</sup> IV infusion over 48 hours once on day 1 | + | **Cycle 9: 2 mg/m<sup>2</sup> IV push once on day 1 (maximum dose of 2 mg) |
| − | **Treat with 50% doses calculated on a m<sup>2</sup> basis for children < 1 year, then consider increasing to 75% and then to 100 % of calculated dose if tolerated | + | ***Treat with 50% doses calculated on a m<sup>2</sup> basis for children < 1 year, then consider increasing to 75% and then to 100 % of calculated dose if tolerated |
| − | *[[Cyclophosphamide (Cytoxan)]] 1200 mg/m<sup>2</sup> IV over 1 hour on Days 1 | + | *[[Doxorubicin (Adriamycin)]] as follows: |
| − | **Treat with 50% doses calculated on a m<sup>2</sup> basis for children < 1 year, then consider increasing to 75% and then to 100 % of calculated dose if tolerated | + | **Cycle 9: 75 mg/m<sup>2</sup> IV infusion over 48 hours once on day 1 |
| − | *[[Mesna (Mesnex)]] 720 mg/m<sup>2</sup> IV continuous infusion on day 1 | + | ***Treat with 50% doses calculated on a m<sup>2</sup> basis for children < 1 year, then consider increasing to 75% and then to 100 % of calculated dose if tolerated |
| − | **NOTE: Protocol states that [[Mesna (Mesnex)]] should be dosed as AT LEAST 60% of [[Cyclophosphamide (Cytoxan)]] m<sup>2</sup> | + | *[[Cyclophosphamide (Cytoxan)]] as follows: |
| − | **[[Mesna (Mesnex)]] continuous infusion should be started at the same time as the [[Cyclophosphamide (Cytoxan)]] and remain until at least 8 hours after the end of the [[Cyclophosphamide (Cytoxan)]] infusion | + | **Cycle 9: 1200 mg/m<sup>2</sup> IV over 1 hour on Days 1 |
| − | *[[Filgrastim (Neupogen)]] 5 mcg/kg SC for at least 7 days, or until ANC ≥ 750/μl, beginning on day 2 | + | ***Treat with 50% doses calculated on a m<sup>2</sup> basis for children < 1 year, then consider increasing to 75% and then to 100 % of calculated dose if tolerated |
| − | **ANC ≥ 750/μl on or before day 7 of the cycle is not sufficient for discontinuing G-CSF | + | ====Supportive medications, VDC portion Regimen B<sub>1</sub> (Surgery Only)==== |
| + | *[[Mesna (Mesnex)]] as follows: | ||
| + | **Cycle 9: 720 mg/m<sup>2</sup> IV continuous infusion on day 1 | ||
| + | ***NOTE: Protocol states that [[Mesna (Mesnex)]] should be dosed as AT LEAST 60% of [[Cyclophosphamide (Cytoxan)]] m<sup>2</sup> | ||
| + | ***[[Mesna (Mesnex)]] continuous infusion should be started at the same time as the [[Cyclophosphamide (Cytoxan)]] and remain until at least 8 hours after the end of the [[Cyclophosphamide (Cytoxan)]] infusion | ||
| + | *[[Filgrastim (Neupogen)]] as follows: | ||
| + | **Cycle 9: 5 mcg/kg SC for at least 7 days, or until ANC ≥ 750/μl, beginning on day 2 | ||
| + | ***ANC ≥ 750/μl on or before day 7 of the cycle is not sufficient for discontinuing G-CSF | ||
'''14 day cycle''' | '''14 day cycle''' | ||
| − | ==== | + | ====Chemotherapy, VC portion Regimen B<sub>2</sub> & B<sub>3</sub> (Radiation w/ or w/o Surgery)==== |
| − | *[[Vincristine (Oncovin)]] 2 mg/m<sup>2</sup> IV push once on day 1 (maximum dose of 2 mg) | + | *[[Vincristine (Oncovin)]] as follows: |
| − | **Treat with 50% doses calculated on a m<sup>2</sup> basis for children < 1 year, then consider increasing to 75% and then to 100 % of calculated dose if tolerated | + | **Cycle 9: 2 mg/m<sup>2</sup> IV push once on day 1 (maximum dose of 2 mg) |
| − | *[[Cyclophosphamide (Cytoxan)]] 1200 mg/m<sup>2</sup> IV over 1 hour on Days 1 | + | ***Treat with 50% doses calculated on a m<sup>2</sup> basis for children < 1 year, then consider increasing to 75% and then to 100 % of calculated dose if tolerated |
| − | **Treat with 50% doses calculated on a m<sup>2</sup> basis for children < 1 year, then consider increasing to 75% and then to 100 % of calculated dose if tolerated | + | *[[Cyclophosphamide (Cytoxan)]] as follows: |
| − | *[[Mesna (Mesnex)]] 720 mg/m<sup>2</sup> IV continuous infusion on day 1 | + | **Cycle 9: 1200 mg/m<sup>2</sup> IV over 1 hour on Days 1 |
| − | **NOTE: Protocol states that [[Mesna (Mesnex)]] should be dosed as AT LEAST 60% of [[Cyclophosphamide (Cytoxan)]] m<sup>2</sup> | + | ***Treat with 50% doses calculated on a m<sup>2</sup> basis for children < 1 year, then consider increasing to 75% and then to 100 % of calculated dose if tolerated |
| − | **[[Mesna (Mesnex)]] continuous infusion should be started at the same time as the [[Cyclophosphamide (Cytoxan)]] and remain until at least 8 hours after the end of the [[Cyclophosphamide (Cytoxan)]] infusion | + | ====Supportive medications, VC portion Regimen B<sub>2</sub> & B<sub>3</sub> (Radiation w/ or w/o Surgery)==== |
| − | *[[Filgrastim (Neupogen)]] 5 mcg/kg SC for at least 7 days, or until ANC ≥ 750/μl, beginning on day 2 | + | *[[Mesna (Mesnex)]] as follows: |
| − | **ANC ≥ 750/μl on or before day 7 of the cycle is not sufficient for discontinuing G-CSF | + | **Cycle 9: 720 mg/m<sup>2</sup> IV continuous infusion on day 1 |
| + | ***NOTE: Protocol states that [[Mesna (Mesnex)]] should be dosed as AT LEAST 60% of [[Cyclophosphamide (Cytoxan)]] m<sup>2</sup> | ||
| + | ***[[Mesna (Mesnex)]] continuous infusion should be started at the same time as the [[Cyclophosphamide (Cytoxan)]] and remain until at least 8 hours after the end of the [[Cyclophosphamide (Cytoxan)]] infusion | ||
| + | *[[Filgrastim (Neupogen)]] as follows: | ||
| + | **Cycle 9: 5 mcg/kg SC for at least 7 days, or until ANC ≥ 750/μl, beginning on day 2 | ||
| + | ***ANC ≥ 750/μl on or before day 7 of the cycle is not sufficient for discontinuing G-CSF | ||
'''14 day cycle''' | '''14 day cycle''' | ||
| − | ==== | + | ====Chemotherapy, VC portion==== |
| − | *[[Vincristine (Oncovin)]] 2 mg/m<sup>2</sup> IV push once on day 1 (maximum dose of 2 mg) | + | *[[Vincristine (Oncovin)]] as follows: |
| − | **Treat with 50% doses calculated on a m<sup>2</sup> basis for children < 1 year, then consider increasing to 75% and then to 100 % of calculated dose if tolerated | + | **Cycle 11: 2 mg/m<sup>2</sup> IV push once on day 1 (maximum dose of 2 mg) |
| − | *[[Cyclophosphamide (Cytoxan)]] 1200 mg/m<sup>2</sup> IV over 1 hour on Days 1 | + | ***Treat with 50% doses calculated on a m<sup>2</sup> basis for children < 1 year, then consider increasing to 75% and then to 100 % of calculated dose if tolerated |
| − | **Treat with 50% doses calculated on a m<sup>2</sup> basis for children < 1 year, then consider increasing to 75% and then to 100 % of calculated dose if tolerated | + | *[[Cyclophosphamide (Cytoxan)]] as follows: |
| − | *[[Mesna (Mesnex)]] 720 mg/m<sup>2</sup> IV continuous infusion on day 1 | + | **Cycle 11: 1200 mg/m<sup>2</sup> IV over 1 hour on Days 1 |
| − | **NOTE: Protocol states that [[Mesna (Mesnex)]] should be dosed as AT LEAST 60% of [[Cyclophosphamide (Cytoxan)]] m<sup>2</sup> | + | ***Treat with 50% doses calculated on a m<sup>2</sup> basis for children < 1 year, then consider increasing to 75% and then to 100 % of calculated dose if tolerated |
| − | **[[Mesna (Mesnex)]] continuous infusion should be started at the same time as the [[Cyclophosphamide (Cytoxan)]] and remain until at least 8 hours after the end of the [[Cyclophosphamide (Cytoxan)]] infusion | + | ====Supportive medications, VC portion==== |
| − | *[[Filgrastim (Neupogen)]] 5 mcg/kg SC for at least 7 days, or until ANC ≥ 750/μl, beginning on day 2 | + | *[[Mesna (Mesnex)]] as follows: |
| − | **ANC ≥ 750/μl on or before day 7 of the cycle is not sufficient for discontinuing G-CSF | + | **Cycle 11: 720 mg/m<sup>2</sup> IV continuous infusion on day 1 |
| + | ***NOTE: Protocol states that [[Mesna (Mesnex)]] should be dosed as AT LEAST 60% of [[Cyclophosphamide (Cytoxan)]] m<sup>2</sup> | ||
| + | ***[[Mesna (Mesnex)]] continuous infusion should be started at the same time as the [[Cyclophosphamide (Cytoxan)]] and remain until at least 8 hours after the end of the [[Cyclophosphamide (Cytoxan)]] infusion | ||
| + | *[[Filgrastim (Neupogen)]] as follows: | ||
| + | **Cycle 11: 5 mcg/kg SC for at least 7 days, or until ANC ≥ 750/μl, beginning on day 2 | ||
| + | ***ANC ≥ 750/μl on or before day 7 of the cycle is not sufficient for discontinuing G-CSF | ||
'''14 day cycle''' | '''14 day cycle''' | ||
| − | ==== | + | ====Chemotherapy, VC portion Regimen B<sub>1</sub> (Surgery Only)==== |
| − | *[[Vincristine (Oncovin)]] 2 mg/m<sup>2</sup> IV push once on day 1 (maximum dose of 2 mg) | + | *[[Vincristine (Oncovin)]] as follows: |
| − | **Treat with 50% doses calculated on a m<sup>2</sup> basis for children < 1 year, then consider increasing to 75% and then to 100 % of calculated dose if tolerated | + | **Cycle 13: 2 mg/m<sup>2</sup> IV push once on day 1 (maximum dose of 2 mg) |
| − | *[[Cyclophosphamide (Cytoxan)]] 1200 mg/m<sup>2</sup> IV over 1 hour on Days 1 | + | ***Treat with 50% doses calculated on a m<sup>2</sup> basis for children < 1 year, then consider increasing to 75% and then to 100 % of calculated dose if tolerated |
| − | **Treat with 50% doses calculated on a m<sup>2</sup> basis for children < 1 year, then consider increasing to 75% and then to 100 % of calculated dose if tolerated | + | *[[Cyclophosphamide (Cytoxan)]] as follows: |
| − | *[[Mesna (Mesnex)]] 720 mg/m<sup>2</sup> IV continuous infusion on day 1 | + | **Cycle 13: 1200 mg/m<sup>2</sup> IV over 1 hour on Days 1 |
| − | **NOTE: Protocol states that [[Mesna (Mesnex)]] should be dosed as AT LEAST 60% of [[Cyclophosphamide (Cytoxan)]] m<sup>2</sup> | + | ***Treat with 50% doses calculated on a m<sup>2</sup> basis for children < 1 year, then consider increasing to 75% and then to 100 % of calculated dose if tolerated |
| − | **[[Mesna (Mesnex)]] continuous infusion should be started at the same time as the [[Cyclophosphamide (Cytoxan)]] and remain until at least 8 hours after the end of the [[Cyclophosphamide (Cytoxan)]] infusion | + | ====Supportive medications, VC portion Regimen B<sub>1</sub> (Surgery Only)==== |
| − | *[[Filgrastim (Neupogen)]] 5 mcg/kg SC for at least 7 days, or until ANC ≥ 750/μl, beginning on day 2 | + | *[[Mesna (Mesnex)]] as follows: |
| − | **ANC ≥ 750/μl on or before day 7 of the cycle is not sufficient for discontinuing G-CSF | + | **Cycle 13: 720 mg/m<sup>2</sup> IV continuous infusion on day 1 |
| + | ***NOTE: Protocol states that [[Mesna (Mesnex)]] should be dosed as AT LEAST 60% of [[Cyclophosphamide (Cytoxan)]] m<sup>2</sup> | ||
| + | ***[[Mesna (Mesnex)]] continuous infusion should be started at the same time as the [[Cyclophosphamide (Cytoxan)]] and remain until at least 8 hours after the end of the [[Cyclophosphamide (Cytoxan)]] infusion | ||
| + | *[[Filgrastim (Neupogen)]] as follows: | ||
| + | **Cycle 13: 5 mcg/kg SC for at least 7 days, or until ANC ≥ 750/μl, beginning on day 2 | ||
| + | ***ANC ≥ 750/μl on or before day 7 of the cycle is not sufficient for discontinuing G-CSF | ||
'''14 day cycle''' | '''14 day cycle''' | ||
| − | ==== | + | ====Chemotherapy, VDC portion Regimen B<sub>2</sub> & B<sub>3</sub> (Radiation w/ or w/o Surgery)==== |
| − | *[[Vincristine (Oncovin)]] 2 mg/m<sup>2</sup> IV push once on day 1 (maximum dose of 2 mg) | + | *[[Vincristine (Oncovin)]] as follows: |
| − | **Treat with 50% doses calculated on a m<sup>2</sup> basis for children < 1 year, then consider increasing to 75% and then to 100 % of calculated dose if tolerated | + | **Cycle 13: 2 mg/m<sup>2</sup> IV push once on day 1 (maximum dose of 2 mg) |
| − | *[[Doxorubicin (Adriamycin)]] 75 mg/m<sup>2</sup> IV infusion over 48 hours once on day 1 | + | ***Treat with 50% doses calculated on a m<sup>2</sup> basis for children < 1 year, then consider increasing to 75% and then to 100 % of calculated dose if tolerated |
| − | **Treat with 50% doses calculated on a m<sup>2</sup> basis for children < 1 year, then consider increasing to 75% and then to 100 % of calculated dose if tolerated | + | *[[Doxorubicin (Adriamycin)]] as follows: |
| − | *[[Cyclophosphamide (Cytoxan)]] 1200 mg/m<sup>2</sup> IV over 1 hour on Days 1 | + | **Cycle 13: 75 mg/m<sup>2</sup> IV infusion over 48 hours once on day 1 |
| − | **Treat with 50% doses calculated on a m<sup>2</sup> basis for children < 1 year, then consider increasing to 75% and then to 100 % of calculated dose if tolerated | + | ***Treat with 50% doses calculated on a m<sup>2</sup> basis for children < 1 year, then consider increasing to 75% and then to 100 % of calculated dose if tolerated |
| − | *[[Mesna (Mesnex)]] 720 mg/m<sup>2</sup> IV continuous infusion on day 1 | + | *[[Cyclophosphamide (Cytoxan)]] as follows: |
| − | **NOTE: Protocol states that [[Mesna (Mesnex)]] should be dosed as AT LEAST 60% of [[Cyclophosphamide (Cytoxan)]] m<sup>2</sup> | + | **Cycle 13: 1200 mg/m<sup>2</sup> IV over 1 hour on Days 1 |
| − | **[[Mesna (Mesnex)]] continuous infusion should be started at the same time as the [[Cyclophosphamide (Cytoxan)]] and remain until at least 8 hours after the end of the [[Cyclophosphamide (Cytoxan)]] infusion | + | ***Treat with 50% doses calculated on a m<sup>2</sup> basis for children < 1 year, then consider increasing to 75% and then to 100 % of calculated dose if tolerated |
| − | *[[Filgrastim (Neupogen)]] 5 mcg/kg SC for at least 7 days, or until ANC ≥ 750/μl, beginning on day 2 | + | ====Supportive medications, VDC portion Regimen B<sub>2</sub> & B<sub>3</sub> (Radiation w/ or w/o Surgery)==== |
| − | **ANC ≥ 750/μl on or before day 7 of the cycle is not sufficient for discontinuing G-CSF | + | *[[Mesna (Mesnex)]] as follows: |
| + | **Cycle 13: 720 mg/m<sup>2</sup> IV continuous infusion on day 1 | ||
| + | ***NOTE: Protocol states that [[Mesna (Mesnex)]] should be dosed as AT LEAST 60% of [[Cyclophosphamide (Cytoxan)]] m<sup>2</sup> | ||
| + | ***[[Mesna (Mesnex)]] continuous infusion should be started at the same time as the [[Cyclophosphamide (Cytoxan)]] and remain until at least 8 hours after the end of the [[Cyclophosphamide (Cytoxan)]] infusion | ||
| + | *[[Filgrastim (Neupogen)]] as follows: | ||
| + | **Cycle 13: 5 mcg/kg SC for at least 7 days, or until ANC ≥ 750/μl, beginning on day 2 | ||
| + | ***ANC ≥ 750/μl on or before day 7 of the cycle is not sufficient for discontinuing G-CSF | ||
'''14 day cycle''' | '''14 day cycle''' | ||
====References==== | ====References==== | ||
Revision as of 08:51, 14 September 2022
The purpose of this page is to provide references to regimens that are obsolete, outdated, or of historical interest only. As a general rule, this includes the inferior arm(s) of a randomized study, unless said regimens continue to be recommended by trustworthy sources such as the NCCN Guidelines. Is there a regimen missing from this list? See the main pediatric Ewing sarcoma page for current regimens.
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Upfront therapy, localized disease
COG AEWS0031 Induction A
Regimen
- Regimen A is a standard regimen consisting of 21 day cycles
Chemotherapy, VDC portion
- Vincristine (Oncovin) as follows:
- Cycles 1 & 3: 2 mg/m2 IV push once on day 1 (maximum dose of 2 mg)
- Treat with 50% doses calculated on a m2 basis for children < 1 year, then consider increasing to 75% and then to 100 % of calculated dose if tolerated
- Cycles 1 & 3: 2 mg/m2 IV push once on day 1 (maximum dose of 2 mg)
- Doxorubicin (Adriamycin) as follows:
- Cycles 1 & 3: 75 mg/m2 IV infusion over 48 hours once on day 1
- Treat with 50% doses calculated on a m2 basis for children < 1 year, then consider increasing to 75% and then to 100 % of calculated dose if tolerated
- Cycles 1 & 3: 75 mg/m2 IV infusion over 48 hours once on day 1
- Cyclophosphamide (Cytoxan) as follows:
- Cycles 1 & 3: 1200 mg/m2 IV over 1 hour on Days 1
- Treat with 50% doses calculated on a m2 basis for children < 1 year, then consider increasing to 75% and then to 100 % of calculated dose if tolerated
- Cycles 1 & 3: 1200 mg/m2 IV over 1 hour on Days 1
Supportive medications, VDC portion
- Mesna (Mesnex) as follows:
- Cycles 1 & 3: 720 mg/m2 IV continuous infusion on day 1
- NOTE: Protocol states that Mesna (Mesnex) should be dosed as AT LEAST 60% of Cyclophosphamide (Cytoxan) m2
- Mesna (Mesnex) continuous infusion should be started at the same time as the Cyclophosphamide (Cytoxan) and remain until at least 8 hours after the end of the Cyclophosphamide (Cytoxan) infusion
- Cycles 1 & 3: 720 mg/m2 IV continuous infusion on day 1
- Filgrastim (Neupogen) as follows:
- Cycles 1 & 3: 5 mcg/kg SC for at least 7 days, or until ANC ≥ 750/μl, beginning on day 2
- ANC ≥ 750/μl on or before day 7 of the cycle is not sufficient for discontinuing G-CSF
- Cycles 1 & 3: 5 mcg/kg SC for at least 7 days, or until ANC ≥ 750/μl, beginning on day 2
21 day cycle
Chemotherapy, IE portion
- Ifosfamide (Ifex) as follows:
- Cycles 2 & 4: 1800 mg/m2 IV infusion over 1 hour once on day 1 to 5
- Treat with 50% doses calculated on a m2 basis for children < 1 year, then consider increasing to 75% and then to 100 % of calculated dose if tolerated
- Cycles 2 & 4: 1800 mg/m2 IV infusion over 1 hour once on day 1 to 5
- Etoposide (Vepesid) as follows:
- Cycles 2 & 4: 100 mg/m2 IV infusion over 1 to 2 hours once on days 1 to 5
- Treat with 50% doses calculated on a m2 basis for children < 1 year, then consider increasing to 75% and then to 100 % of calculated dose if tolerated
- Cycles 2 & 4: 100 mg/m2 IV infusion over 1 to 2 hours once on days 1 to 5
Supportive medications, IE portion
- Mesna (Mesnex) as follows:
- Cycles 2 & 4: 1080 mg/m2 IV continuous infusion on day 1
- NOTE: Protocol states that Mesna (Mesnex) should be dosed as AT LEAST 60% of Ifosfamide (Ifex) m2
- Mesna (Mesnex) continuous infusion should be started at the same time as the Ifosfamide (Ifex) and remain until at least 8 hours after the end of the Ifosfamide (Ifex) infusion
- Cycles 2 & 4: 1080 mg/m2 IV continuous infusion on day 1
- Filgrastim (Neupogen) as follows:
- Cycles 2 & 4: 5 mcg/kg SC for at least 7 days, or until ANC ≥ 750/μl, beginning on day 6
- ANC ≥ 750/μl on or before day 7 of the cycle is not sufficient for discontinuing G-CSF
- Cycles 2 & 4: 5 mcg/kg SC for at least 7 days, or until ANC ≥ 750/μl, beginning on day 6
21 day cycle
COG AEWS0031 Continuation A
- At week 13 patients either underwent surgery, received radiation, or both
- Radiation coincided with cycle 5
Regimen
Chemotherapy, VDC portion
Cycle 5 begins on week 15 in patients receiving surgery and on week 13 in Regimen A2
- Vincristine (Oncovin) as follows:
- Cycle 5 & 9: 2 mg/m2 IV push once on day 1 (maximum dose of 2 mg)
- Treat with 50% doses calculated on a m2 basis for children < 1 year, then consider increasing to 75% and then to 100 % of calculated dose if tolerated
- Cycle 5 & 9: 2 mg/m2 IV push once on day 1 (maximum dose of 2 mg)
- Doxorubicin (Adriamycin) as follows:
- Cycle 5 & 9: 75 mg/m2 IV infusion over 48 hours once on day 1
- Treat with 50% doses calculated on a m2 basis for children < 1 year, then consider increasing to 75% and then to 100 % of calculated dose if tolerated
- Cycle 5 & 9: 75 mg/m2 IV infusion over 48 hours once on day 1
- Cyclophosphamide (Cytoxan) as follows:
- Cycle 5 & 9: 1200 mg/m2 IV over 1 hour on Days 1
- Treat with 50% doses calculated on a m2 basis for children < 1 year, then consider increasing to 75% and then to 100 % of calculated dose if tolerated
- Cycle 5 & 9: 1200 mg/m2 IV over 1 hour on Days 1
Supportive medication, VDC portion
- Mesna (Mesnex) as follows:
- Cycle 5 & 9: 720 mg/m2 IV continuous infusion on day 1
- NOTE: Protocol states that Mesna (Mesnex) should be dosed as AT LEAST 60% of Cyclophosphamide (Cytoxan) m2
- Mesna (Mesnex) continuous infusion should be started at the same time as the Cyclophosphamide (Cytoxan) and remain until at least 8 hours after the end of the Cyclophosphamide (Cytoxan) infusion
- Cycle 5 & 9: 720 mg/m2 IV continuous infusion on day 1
- Filgrastim (Neupogen) as follows:
- Cycle 5 & 9: 5 mcg/kg SC for at least 7 days, or until ANC ≥ 750/μl, beginning on day 2
- ANC ≥ 750/μl on or before day 7 of the cycle is not sufficient for discontinuing G-CSF
- Cycle 5 & 9: 5 mcg/kg SC for at least 7 days, or until ANC ≥ 750/μl, beginning on day 2
21 day cycle
Chemotherapy, IE portion
- Ifosfamide (Ifex) as follows:
- Cycle 6, 8, 10, 12, & 14: 1800 mg/m2 IV infusion over 1 hour once on day 1 to 5
- Treat with 50% doses calculated on a m2 basis for children < 1 year, then consider increasing to 75% and then to 100 % of calculated dose if tolerated
- Cycle 6, 8, 10, 12, & 14: 1800 mg/m2 IV infusion over 1 hour once on day 1 to 5
- Etoposide (Vepesid) as follows:
- Cycle 6, 8, 10, 12, & 14: 100 mg/m2 IV infusion over 1 to 2 hours once on days 1 to 5
- Treat with 50% doses calculated on a m2 basis for children < 1 year, then consider increasing to 75% and then to 100 % of calculated dose if tolerated
- Cycle 6, 8, 10, 12, & 14: 100 mg/m2 IV infusion over 1 to 2 hours once on days 1 to 5
Supportive medications, IE portion
- Mesna (Mesnex) as follows:
- Cycle 6, 8, 10, 12, & 14: 1080 mg/m2 IV continuous infusion on day 1
- NOTE: Protocol states that Mesna (Mesnex) should be dosed as AT LEAST 60% of Ifosfamide (Ifex) m2
- Mesna (Mesnex) continuous infusion should be started at the same time as the Ifosfamide (Ifex) and remain until at least 8 hours after the end of the Ifosfamide (Ifex) infusion
- Cycle 6, 8, 10, 12, & 14: 1080 mg/m2 IV continuous infusion on day 1
- Filgrastim (Neupogen) as follows:
- Cycle 6, 8, 10, 12, & 14: 5 mcg/kg SC for at least 7 days, or until ANC ≥ 750/μl, beginning on day 6
- ANC ≥ 750/μl on or before day 7 of the cycle is not sufficient for discontinuing G-CSF
- Cycle 6, 8, 10, 12, & 14: 5 mcg/kg SC for at least 7 days, or until ANC ≥ 750/μl, beginning on day 6
21 day cycle
Chemotherapy, VDC portion Regimen A1 (Surgery Only)
- Vincristine (Oncovin) as follows:
- Cycle 7: 2 mg/m2 IV push once on day 1 (maximum dose of 2 mg)
- Treat with 50% doses calculated on a m2 basis for children < 1 year, then consider increasing to 75% and then to 100 % of calculated dose if tolerated
- Cycle 7: 2 mg/m2 IV push once on day 1 (maximum dose of 2 mg)
- Doxorubicin (Adriamycin) as follows:
- Cycle 7: 75 mg/m2 IV infusion over 48 hours once on day 1
- Treat with 50% doses calculated on a m2 basis for children < 1 year, then consider increasing to 75% and then to 100 % of calculated dose if tolerated
- Cycle 7: 75 mg/m2 IV infusion over 48 hours once on day 1
- Cyclophosphamide (Cytoxan) as follows:
- Cycle 7: 1200 mg/m2 IV over 1 hour on Days 1
- Treat with 50% doses calculated on a m2 basis for children < 1 year, then consider increasing to 75% and then to 100 % of calculated dose if tolerated
- Cycle 7: 1200 mg/m2 IV over 1 hour on Days 1
Supportive therapy, VDC portion Regimen A1 (Surgery Only)
- Mesna (Mesnex) as follows:
- Cycle 7: 720 mg/m2 IV continuous infusion on day 1
- NOTE: Protocol states that Mesna (Mesnex) should be dosed as AT LEAST 60% of Cyclophosphamide (Cytoxan) m2
- Mesna (Mesnex) continuous infusion should be started at the same time as the Cyclophosphamide (Cytoxan) and remain until at least 8 hours after the end of the Cyclophosphamide (Cytoxan) infusion
- Cycle 7: 720 mg/m2 IV continuous infusion on day 1
- Filgrastim (Neupogen) as follows:
- Cycle 7: 5 mcg/kg SC for at least 7 days, or until ANC ≥ 750/μl, beginning on day 2
- ANC ≥ 750/μl on or before day 7 of the cycle is not sufficient for discontinuing G-CSF
21 day cycle
Chemotherapy, VC portion Regimen A2 & A3 (Radiation w/ or w/o Surgery)
- Vincristine (Oncovin) as follows:
- Cycle 7: 2 mg/m2 IV push once on day 1 (maximum dose of 2 mg)
- Treat with 50% doses calculated on a m2 basis for children < 1 year, then consider increasing to 75% and then to 100 % of calculated dose if tolerated
- Cycle 7: 2 mg/m2 IV push once on day 1 (maximum dose of 2 mg)
- Cyclophosphamide (Cytoxan) as follows:
- Cycle 7: 1200 mg/m2 IV over 1 hour on Days 1
- Treat with 50% doses calculated on a m2 basis for children < 1 year, then consider increasing to 75% and then to 100 % of calculated dose if tolerated
- Cycle 7: 1200 mg/m2 IV over 1 hour on Days 1
Supportive medications, VC portion Regimen A2 & A3 (Radiation w/ or w/o Surgery)
- Mesna (Mesnex) as follows:
- Cycle 7: 720 mg/m2 IV continuous infusion on day 1
- NOTE: Protocol states that Mesna (Mesnex) should be dosed as AT LEAST 60% of Cyclophosphamide (Cytoxan) m2
- Mesna (Mesnex) continuous infusion should be started at the same time as the Cyclophosphamide (Cytoxan) and remain until at least 8 hours after the end of the Cyclophosphamide (Cytoxan) infusion
- Cycle 7: 720 mg/m2 IV continuous infusion on day 1
- Filgrastim (Neupogen) as follows:
- Cycle 7: 5 mcg/kg SC for at least 7 days, or until ANC ≥ 750/μl, beginning on day 2
- ANC ≥ 750/μl on or before day 7 of the cycle is not sufficient for discontinuing G-CSF
21 day cycle
Chemotherapy, VC portion Regimen A1 (Surgery Only)
- Vincristine (Oncovin) as follows:
- Cycle 11: 2 mg/m2 IV push once on day 1 (maximum dose of 2 mg)
- Treat with 50% doses calculated on a m2 basis for children < 1 year, then consider increasing to 75% and then to 100 % of calculated dose if tolerated
- Cycle 11: 2 mg/m2 IV push once on day 1 (maximum dose of 2 mg)
- Cyclophosphamide (Cytoxan) as follows:
- Cycle 11: 1200 mg/m2 IV over 1 hour on Days 1
- Treat with 50% doses calculated on a m2 basis for children < 1 year, then consider increasing to 75% and then to 100 % of calculated dose if tolerated
- Cycle 11: 1200 mg/m2 IV over 1 hour on Days 1
Supportive medications, VC portion Regimen A1 (Surgery Only)
- Mesna (Mesnex) as follows:
- Cycle 11: 720 mg/m2 IV continuous infusion on day 1
- NOTE: Protocol states that Mesna (Mesnex) should be dosed as AT LEAST 60% of Cyclophosphamide (Cytoxan) m2
- Mesna (Mesnex) continuous infusion should be started at the same time as the Cyclophosphamide (Cytoxan) and remain until at least 8 hours after the end of the Cyclophosphamide (Cytoxan) infusion
- Cycle 11: 720 mg/m2 IV continuous infusion on day 1
- Filgrastim (Neupogen) as follows:
- Cycle 11: 5 mcg/kg SC for at least 7 days, or until ANC ≥ 750/μl, beginning on day 2
- ANC ≥ 750/μl on or before day 7 of the cycle is not sufficient for discontinuing G-CSF
- Cycle 11: 5 mcg/kg SC for at least 7 days, or until ANC ≥ 750/μl, beginning on day 2
21 day cycle
Chemotherapy, VDC portion Regimen A2 & A3 (Radiation w/ or w/o Surgery)
- Vincristine (Oncovin) as follows:
- Cycle 11: 2 mg/m2 IV push once on day 1 (maximum dose of 2 mg)
- Treat with 50% doses calculated on a m2 basis for children < 1 year, then consider increasing to 75% and then to 100 % of calculated dose if tolerated
- Cycle 11: 2 mg/m2 IV push once on day 1 (maximum dose of 2 mg)
- Doxorubicin (Adriamycin) as follows:
- Cycle 11: 75 mg/m2 IV infusion over 48 hours once on day 1
- Treat with 50% doses calculated on a m2 basis for children < 1 year, then consider increasing to 75% and then to 100 % of calculated dose if tolerated
- Cycle 11: 75 mg/m2 IV infusion over 48 hours once on day 1
- Cyclophosphamide (Cytoxan) as follows:
- Cycle 11: 1200 mg/m2 IV over 1 hour on Days 1
- Treat with 50% doses calculated on a m2 basis for children < 1 year, then consider increasing to 75% and then to 100 % of calculated dose if tolerated
- Cycle 11: 1200 mg/m2 IV over 1 hour on Days 1
Supportive medications, VDC portion Regimen A2 & A3 (Radiation w/ or w/o Surgery)
- Mesna (Mesnex) as follows:
- Cycle 11: 720 mg/m2 IV continuous infusion on day 1
- NOTE: Protocol states that Mesna (Mesnex) should be dosed as AT LEAST 60% of Cyclophosphamide (Cytoxan) m2
- Mesna (Mesnex) continuous infusion should be started at the same time as the Cyclophosphamide (Cytoxan) and remain until at least 8 hours after the end of the Cyclophosphamide (Cytoxan) infusion
- Cycle 11: 720 mg/m2 IV continuous infusion on day 1
- Filgrastim (Neupogen) as follows:
- Cycle 11: 5 mcg/kg SC for at least 7 days, or until ANC ≥ 750/μl, beginning on day 2
- ANC ≥ 750/μl on or before day 7 of the cycle is not sufficient for discontinuing G-CSF
21 day cycle
Chemotherapy, VC portion
- Vincristine (Oncovin) as follows:
- Cycle 13: 2 mg/m2 IV push once on day 1 (maximum dose of 2 mg)
- Treat with 50% doses calculated on a m2 basis for children < 1 year, then consider increasing to 75% and then to 100 % of calculated dose if tolerated
- Cycle 13: 2 mg/m2 IV push once on day 1 (maximum dose of 2 mg)
- Cyclophosphamide (Cytoxan) as follows:
- Cycle 13: 1200 mg/m2 IV over 1 hour on Days 1
- Treat with 50% doses calculated on a m2 basis for children < 1 year, then consider increasing to 75% and then to 100 % of calculated dose if tolerated
- Cycle 13: 1200 mg/m2 IV over 1 hour on Days 1
Supportive medications, VC portion
- Mesna (Mesnex) as follows:
- Cycle 13: 720 mg/m2 IV continuous infusion on day 1
- NOTE: Protocol states that Mesna (Mesnex) should be dosed as AT LEAST 60% of Cyclophosphamide (Cytoxan) m2
- Mesna (Mesnex) continuous infusion should be started at the same time as the Cyclophosphamide (Cytoxan) and remain until at least 8 hours after the end of the Cyclophosphamide (Cytoxan) infusion
- Cycle 13: 720 mg/m2 IV continuous infusion on day 1
- Filgrastim (Neupogen) as follows:
- Cycle 13: 5 mcg/kg SC for at least 7 days, or until ANC ≥ 750/μl, beginning on day 2
- ANC ≥ 750/μl on or before day 7 of the cycle is not sufficient for discontinuing G-CSF
- Cycle 13: 5 mcg/kg SC for at least 7 days, or until ANC ≥ 750/μl, beginning on day 2
21 day cycle
COG AEWS0031 Induction B
- Regimen B is a consolidated regimen consisting of 14 day cycles
Regimen
Chemotherapy, VDC portion
- Vincristine (Oncovin) as follows:
- Cycles 1, 3, & 5: 2 mg/m2 IV push once on day 1 (maximum dose of 2 mg)
- Treat with 50% doses calculated on a m2 basis for children < 1 year, then consider increasing to 75% and then to 100 % of calculated dose if tolerated
- Cycles 1, 3, & 5: 2 mg/m2 IV push once on day 1 (maximum dose of 2 mg)
- Doxorubicin (Adriamycin) as follows:
- Cycles 1, 3, & 5: 75 mg/m2 IV infusion over 48 hours once on day 1
- Treat with 50% doses calculated on a m2 basis for children < 1 year, then consider increasing to 75% and then to 100 % of calculated dose if tolerated
- Cycles 1, 3, & 5: 75 mg/m2 IV infusion over 48 hours once on day 1
- Cyclophosphamide (Cytoxan) as follows:
- Cycles 1, 3, & 5: 1200 mg/m2 IV over 1 hour on Days 1
- Treat with 50% doses calculated on a m2 basis for children < 1 year, then consider increasing to 75% and then to 100 % of calculated dose if tolerated
- Cycles 1, 3, & 5: 1200 mg/m2 IV over 1 hour on Days 1
Supportive medications, VDC portion
- Mesna (Mesnex) as follows:
- Cycles 1, 3, & 5: 720 mg/m2 IV continuous infusion on day 1
- NOTE: Protocol states that Mesna (Mesnex) should be dosed as AT LEAST 60% of Cyclophosphamide (Cytoxan) m2
- Mesna (Mesnex) continuous infusion should be started at the same time as the Cyclophosphamide (Cytoxan) and remain until at least 8 hours after the end of the Cyclophosphamide (Cytoxan) infusion
- Cycles 1, 3, & 5: 720 mg/m2 IV continuous infusion on day 1
- Filgrastim (Neupogen) as follows:
- Cycles 1, 3, & 5: 5 mcg/kg SC for at least 7 days, or until ANC ≥ 750/μl, beginning on day 2
- ANC ≥ 750/μl on or before day 7 of the cycle is not sufficient for discontinuing G-CSF
- Cycles 1, 3, & 5: 5 mcg/kg SC for at least 7 days, or until ANC ≥ 750/μl, beginning on day 2
14 day cycle
Chemotherapy, IE portion
- Ifosfamide (Ifex) as follows:
- Cycle 2, 4, & 6: 1800 mg/m2 IV infusion over 1 hour once on day 1 to 5
- Treat with 50% doses calculated on a m2 basis for children < 1 year, then consider increasing to 75% and then to 100 % of calculated dose if tolerated
- Cycle 2, 4, & 6: 1800 mg/m2 IV infusion over 1 hour once on day 1 to 5
- Etoposide (Vepesid) as follows:
- Cycle 2, 4, & 6: 100 mg/m2 IV infusion over 1 to 2 hours once on days 1 to 5
- Treat with 50% doses calculated on a m2 basis for children < 1 year, then consider increasing to 75% and then to 100 % of calculated dose if tolerated
- Cycle 2, 4, & 6: 100 mg/m2 IV infusion over 1 to 2 hours once on days 1 to 5
Supportive medications, IE portion
- Mesna (Mesnex) as follows:
- Cycle 2, 4, & 6: 1080 mg/m2 IV continuous infusion on day 1
- NOTE: Protocol states that Mesna (Mesnex) should be dosed as AT LEAST 60% of Ifosfamide (Ifex) m2
- Mesna (Mesnex) continuous infusion should be started at the same time as the Ifosfamide (Ifex) and remain until at least 8 hours after the end of the Ifosfamide (Ifex) infusion
- Cycle 2, 4, & 6: 1080 mg/m2 IV continuous infusion on day 1
- Filgrastim (Neupogen) as follows:
- Cycle 2, 4, & 6: 5 mcg/kg SC for at least 7 days, or until ANC ≥ 750/μl, beginning on day 6
- ANC ≥ 750/μl on or before day 7 of the cycle is not sufficient for discontinuing G-CSF
- Cycle 2, 4, & 6: 5 mcg/kg SC for at least 7 days, or until ANC ≥ 750/μl, beginning on day 6
14 day cycle
COG AEWS0031 Continuation B
- At week 13 patients either underwent surgery, received radiation, or both
- Radiation coincided with cycle 7
Regimen
Chemotherapy, VDC portion
Cycle 7 begins on week 15 in patients receiving surgery and on week 13 in Regimen B2
- Vincristine (Oncovin) as follows:
- Cycle 7: 2 mg/m2 IV push once on day 1 (maximum dose of 2 mg)
- Treat with 50% doses calculated on a m2 basis for children < 1 year, then consider increasing to 75% and then to 100 % of calculated dose if tolerated
- Cycle 7: 2 mg/m2 IV push once on day 1 (maximum dose of 2 mg)
- Doxorubicin (Adriamycin) as follows:
- Cycle 7: 75 mg/m2 IV infusion over 48 hours once on day 1
- Treat with 50% doses calculated on a m2 basis for children < 1 year, then consider increasing to 75% and then to 100 % of calculated dose if tolerated
- Cycle 7: 75 mg/m2 IV infusion over 48 hours once on day 1
- Cyclophosphamide (Cytoxan) as follows:
- Cycle 7: 1200 mg/m2 IV over 1 hour on Days 1
- Treat with 50% doses calculated on a m2 basis for children < 1 year, then consider increasing to 75% and then to 100 % of calculated dose if tolerated
- Cycle 7: 1200 mg/m2 IV over 1 hour on Days 1
Supportive medications, VDC portion
- Mesna (Mesnex) as follows:
- Cycle 7: 720 mg/m2 IV continuous infusion on day 1
- NOTE: Protocol states that Mesna (Mesnex) should be dosed as AT LEAST 60% of Cyclophosphamide (Cytoxan) m2
- Mesna (Mesnex) continuous infusion should be started at the same time as the Cyclophosphamide (Cytoxan) and remain until at least 8 hours after the end of the Cyclophosphamide (Cytoxan) infusion
- Cycle 7: 720 mg/m2 IV continuous infusion on day 1
- Filgrastim (Neupogen) as follows:
- Cycle 7: 5 mcg/kg SC for at least 7 days, or until ANC ≥ 750/μl, beginning on day 2
- ANC ≥ 750/μl on or before day 7 of the cycle is not sufficient for discontinuing G-CSF
- Cycle 7: 5 mcg/kg SC for at least 7 days, or until ANC ≥ 750/μl, beginning on day 2
14 day cycle
Chemotherapy, IE portion
- Ifosfamide (Ifex) as follows:
- Cycle 8, 10, 12, & 14: 1800 mg/m2 IV infusion over 1 hour once on day 1 to 5
- Treat with 50% doses calculated on a m2 basis for children < 1 year, then consider increasing to 75% and then to 100 % of calculated dose if tolerated
- Cycle 8, 10, 12, & 14: 1800 mg/m2 IV infusion over 1 hour once on day 1 to 5
- Etoposide (Vepesid) as follows:
- Cycle 8, 10, 12, & 14: 100 mg/m2 IV infusion over 1 to 2 hours once on days 1 to 5
- Treat with 50% doses calculated on a m2 basis for children < 1 year, then consider increasing to 75% and then to 100 % of calculated dose if tolerated
- Cycle 8, 10, 12, & 14: 100 mg/m2 IV infusion over 1 to 2 hours once on days 1 to 5
Supportive medications, IE portion
- Mesna (Mesnex) as follows:
- Cycle 8, 10, 12, & 14: 1080 mg/m2 IV continuous infusion on day 1
- NOTE: Protocol states that Mesna (Mesnex) should be dosed as AT LEAST 60% of Ifosfamide (Ifex) m2
- Mesna (Mesnex) continuous infusion should be started at the same time as the Ifosfamide (Ifex) and remain until at least 8 hours after the end of the Ifosfamide (Ifex) infusion
- Cycle 8, 10, 12, & 14: 1080 mg/m2 IV continuous infusion on day 1
- Filgrastim (Neupogen) as follows:
- Cycle 8, 10, 12, & 14: 5 mcg/kg SC for at least 7 days, or until ANC ≥ 750/μl, beginning on day 6
- ANC ≥ 750/μl on or before day 7 of the cycle is not sufficient for discontinuing G-CSF
- Cycle 8, 10, 12, & 14: 5 mcg/kg SC for at least 7 days, or until ANC ≥ 750/μl, beginning on day 6
14 day cycle
Chemotherapy, VDC portion Regimen B1 (Surgery Only)
- Vincristine (Oncovin) as follows:
- Cycle 9: 2 mg/m2 IV push once on day 1 (maximum dose of 2 mg)
- Treat with 50% doses calculated on a m2 basis for children < 1 year, then consider increasing to 75% and then to 100 % of calculated dose if tolerated
- Cycle 9: 2 mg/m2 IV push once on day 1 (maximum dose of 2 mg)
- Doxorubicin (Adriamycin) as follows:
- Cycle 9: 75 mg/m2 IV infusion over 48 hours once on day 1
- Treat with 50% doses calculated on a m2 basis for children < 1 year, then consider increasing to 75% and then to 100 % of calculated dose if tolerated
- Cycle 9: 75 mg/m2 IV infusion over 48 hours once on day 1
- Cyclophosphamide (Cytoxan) as follows:
- Cycle 9: 1200 mg/m2 IV over 1 hour on Days 1
- Treat with 50% doses calculated on a m2 basis for children < 1 year, then consider increasing to 75% and then to 100 % of calculated dose if tolerated
- Cycle 9: 1200 mg/m2 IV over 1 hour on Days 1
Supportive medications, VDC portion Regimen B1 (Surgery Only)
- Mesna (Mesnex) as follows:
- Cycle 9: 720 mg/m2 IV continuous infusion on day 1
- NOTE: Protocol states that Mesna (Mesnex) should be dosed as AT LEAST 60% of Cyclophosphamide (Cytoxan) m2
- Mesna (Mesnex) continuous infusion should be started at the same time as the Cyclophosphamide (Cytoxan) and remain until at least 8 hours after the end of the Cyclophosphamide (Cytoxan) infusion
- Cycle 9: 720 mg/m2 IV continuous infusion on day 1
- Filgrastim (Neupogen) as follows:
- Cycle 9: 5 mcg/kg SC for at least 7 days, or until ANC ≥ 750/μl, beginning on day 2
- ANC ≥ 750/μl on or before day 7 of the cycle is not sufficient for discontinuing G-CSF
- Cycle 9: 5 mcg/kg SC for at least 7 days, or until ANC ≥ 750/μl, beginning on day 2
14 day cycle
Chemotherapy, VC portion Regimen B2 & B3 (Radiation w/ or w/o Surgery)
- Vincristine (Oncovin) as follows:
- Cycle 9: 2 mg/m2 IV push once on day 1 (maximum dose of 2 mg)
- Treat with 50% doses calculated on a m2 basis for children < 1 year, then consider increasing to 75% and then to 100 % of calculated dose if tolerated
- Cycle 9: 2 mg/m2 IV push once on day 1 (maximum dose of 2 mg)
- Cyclophosphamide (Cytoxan) as follows:
- Cycle 9: 1200 mg/m2 IV over 1 hour on Days 1
- Treat with 50% doses calculated on a m2 basis for children < 1 year, then consider increasing to 75% and then to 100 % of calculated dose if tolerated
- Cycle 9: 1200 mg/m2 IV over 1 hour on Days 1
Supportive medications, VC portion Regimen B2 & B3 (Radiation w/ or w/o Surgery)
- Mesna (Mesnex) as follows:
- Cycle 9: 720 mg/m2 IV continuous infusion on day 1
- NOTE: Protocol states that Mesna (Mesnex) should be dosed as AT LEAST 60% of Cyclophosphamide (Cytoxan) m2
- Mesna (Mesnex) continuous infusion should be started at the same time as the Cyclophosphamide (Cytoxan) and remain until at least 8 hours after the end of the Cyclophosphamide (Cytoxan) infusion
- Cycle 9: 720 mg/m2 IV continuous infusion on day 1
- Filgrastim (Neupogen) as follows:
- Cycle 9: 5 mcg/kg SC for at least 7 days, or until ANC ≥ 750/μl, beginning on day 2
- ANC ≥ 750/μl on or before day 7 of the cycle is not sufficient for discontinuing G-CSF
- Cycle 9: 5 mcg/kg SC for at least 7 days, or until ANC ≥ 750/μl, beginning on day 2
14 day cycle
Chemotherapy, VC portion
- Vincristine (Oncovin) as follows:
- Cycle 11: 2 mg/m2 IV push once on day 1 (maximum dose of 2 mg)
- Treat with 50% doses calculated on a m2 basis for children < 1 year, then consider increasing to 75% and then to 100 % of calculated dose if tolerated
- Cycle 11: 2 mg/m2 IV push once on day 1 (maximum dose of 2 mg)
- Cyclophosphamide (Cytoxan) as follows:
- Cycle 11: 1200 mg/m2 IV over 1 hour on Days 1
- Treat with 50% doses calculated on a m2 basis for children < 1 year, then consider increasing to 75% and then to 100 % of calculated dose if tolerated
- Cycle 11: 1200 mg/m2 IV over 1 hour on Days 1
Supportive medications, VC portion
- Mesna (Mesnex) as follows:
- Cycle 11: 720 mg/m2 IV continuous infusion on day 1
- NOTE: Protocol states that Mesna (Mesnex) should be dosed as AT LEAST 60% of Cyclophosphamide (Cytoxan) m2
- Mesna (Mesnex) continuous infusion should be started at the same time as the Cyclophosphamide (Cytoxan) and remain until at least 8 hours after the end of the Cyclophosphamide (Cytoxan) infusion
- Cycle 11: 720 mg/m2 IV continuous infusion on day 1
- Filgrastim (Neupogen) as follows:
- Cycle 11: 5 mcg/kg SC for at least 7 days, or until ANC ≥ 750/μl, beginning on day 2
- ANC ≥ 750/μl on or before day 7 of the cycle is not sufficient for discontinuing G-CSF
- Cycle 11: 5 mcg/kg SC for at least 7 days, or until ANC ≥ 750/μl, beginning on day 2
14 day cycle
Chemotherapy, VC portion Regimen B1 (Surgery Only)
- Vincristine (Oncovin) as follows:
- Cycle 13: 2 mg/m2 IV push once on day 1 (maximum dose of 2 mg)
- Treat with 50% doses calculated on a m2 basis for children < 1 year, then consider increasing to 75% and then to 100 % of calculated dose if tolerated
- Cycle 13: 2 mg/m2 IV push once on day 1 (maximum dose of 2 mg)
- Cyclophosphamide (Cytoxan) as follows:
- Cycle 13: 1200 mg/m2 IV over 1 hour on Days 1
- Treat with 50% doses calculated on a m2 basis for children < 1 year, then consider increasing to 75% and then to 100 % of calculated dose if tolerated
- Cycle 13: 1200 mg/m2 IV over 1 hour on Days 1
Supportive medications, VC portion Regimen B1 (Surgery Only)
- Mesna (Mesnex) as follows:
- Cycle 13: 720 mg/m2 IV continuous infusion on day 1
- NOTE: Protocol states that Mesna (Mesnex) should be dosed as AT LEAST 60% of Cyclophosphamide (Cytoxan) m2
- Mesna (Mesnex) continuous infusion should be started at the same time as the Cyclophosphamide (Cytoxan) and remain until at least 8 hours after the end of the Cyclophosphamide (Cytoxan) infusion
- Cycle 13: 720 mg/m2 IV continuous infusion on day 1
- Filgrastim (Neupogen) as follows:
- Cycle 13: 5 mcg/kg SC for at least 7 days, or until ANC ≥ 750/μl, beginning on day 2
- ANC ≥ 750/μl on or before day 7 of the cycle is not sufficient for discontinuing G-CSF
- Cycle 13: 5 mcg/kg SC for at least 7 days, or until ANC ≥ 750/μl, beginning on day 2
14 day cycle
Chemotherapy, VDC portion Regimen B2 & B3 (Radiation w/ or w/o Surgery)
- Vincristine (Oncovin) as follows:
- Cycle 13: 2 mg/m2 IV push once on day 1 (maximum dose of 2 mg)
- Treat with 50% doses calculated on a m2 basis for children < 1 year, then consider increasing to 75% and then to 100 % of calculated dose if tolerated
- Cycle 13: 2 mg/m2 IV push once on day 1 (maximum dose of 2 mg)
- Doxorubicin (Adriamycin) as follows:
- Cycle 13: 75 mg/m2 IV infusion over 48 hours once on day 1
- Treat with 50% doses calculated on a m2 basis for children < 1 year, then consider increasing to 75% and then to 100 % of calculated dose if tolerated
- Cycle 13: 75 mg/m2 IV infusion over 48 hours once on day 1
- Cyclophosphamide (Cytoxan) as follows:
- Cycle 13: 1200 mg/m2 IV over 1 hour on Days 1
- Treat with 50% doses calculated on a m2 basis for children < 1 year, then consider increasing to 75% and then to 100 % of calculated dose if tolerated
- Cycle 13: 1200 mg/m2 IV over 1 hour on Days 1
Supportive medications, VDC portion Regimen B2 & B3 (Radiation w/ or w/o Surgery)
- Mesna (Mesnex) as follows:
- Cycle 13: 720 mg/m2 IV continuous infusion on day 1
- NOTE: Protocol states that Mesna (Mesnex) should be dosed as AT LEAST 60% of Cyclophosphamide (Cytoxan) m2
- Mesna (Mesnex) continuous infusion should be started at the same time as the Cyclophosphamide (Cytoxan) and remain until at least 8 hours after the end of the Cyclophosphamide (Cytoxan) infusion
- Cycle 13: 720 mg/m2 IV continuous infusion on day 1
- Filgrastim (Neupogen) as follows:
- Cycle 13: 5 mcg/kg SC for at least 7 days, or until ANC ≥ 750/μl, beginning on day 2
- ANC ≥ 750/μl on or before day 7 of the cycle is not sufficient for discontinuing G-CSF
- Cycle 13: 5 mcg/kg SC for at least 7 days, or until ANC ≥ 750/μl, beginning on day 2
14 day cycle
References
- COG AEWS0031: Womer RB, West DC, Krailo MD, Dickman PS, Pawel BR, Grier HE, Marcus K, Sailer S, Healey JH, Dormans JP, and Weiss AR. Randomized Controlled Trial of Interval-Compressed Chemotherapy for the Treatment of Localized Ewing Sarcoma: A Report From the Children's Oncology Group. J Clin Oncol. 2012 Nov 20;30(33):4148-4154. link to original article link to PMC article PubMed NCT00006734