Difference between revisions of "Neuroblastoma - historical"
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====Chemotherapy==== | ====Chemotherapy==== | ||
*[[Isotretinoin (Accutane)]] by the following weight-based criteria: | *[[Isotretinoin (Accutane)]] by the following weight-based criteria: | ||
− | **≤ 12 kg: 5.33 mg/kg (Round dose to nearest 10 mg) PO twice | + | **≤ 12 kg: 5.33 mg/kg (Round dose to nearest 10 mg) PO twice per day on days 1 through 14 |
− | **> 12 kg: 160 mg/m<sup>2</sup> (Round dose to nearest 10 mg) PO twice | + | **> 12 kg: 160 mg/m<sup>2</sup> (Round dose to nearest 10 mg) PO twice per day on days 1 through 14 |
'''28-day cycle for 6 cycles''' | '''28-day cycle for 6 cycles''' | ||
</div></div></div> | </div></div></div> | ||
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====Chemotherapy==== | ====Chemotherapy==== | ||
*[[Isotretinoin (Accutane)]] by the following weight-based criteria: | *[[Isotretinoin (Accutane)]] by the following weight-based criteria: | ||
− | **≤ 12 kg: 5.33 mg/kg (Round dose to nearest 10 mg) PO twice | + | **≤ 12 kg: 5.33 mg/kg (Round dose to nearest 10 mg) PO twice per day on days 1 through 14 |
− | **> 12 kg: 160 mg/m<sup>2</sup> (Round dose to nearest 10 mg) PO twice | + | **> 12 kg: 160 mg/m<sup>2</sup> (Round dose to nearest 10 mg) PO twice per day on days 1 through 14 |
'''28-day cycle for 6 cycles''' | '''28-day cycle for 6 cycles''' | ||
</div></div></div> | </div></div></div> | ||
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====Chemotherapy, 6 cycles==== | ====Chemotherapy, 6 cycles==== | ||
*[[Isotretinoin (Accutane)]] by the following weight-based criteria: | *[[Isotretinoin (Accutane)]] by the following weight-based criteria: | ||
− | **≤ 12 kg: 5.33 mg/kg (Round dose to nearest 10 mg) PO twice | + | **≤ 12 kg: 5.33 mg/kg (Round dose to nearest 10 mg) PO twice per day on days 1 through 14 |
− | **> 12 kg: 160 mg/m<sup>2</sup> (Round dose to nearest 10 mg) PO twice | + | **> 12 kg: 160 mg/m<sup>2</sup> (Round dose to nearest 10 mg) PO twice per day on days 1 through 14 |
'''28 Day Cycle''' | '''28 Day Cycle''' | ||
</div></div></div> | </div></div></div> |
Revision as of 19:33, 20 May 2023
Section editor transclusions The purpose of this page is to provide references to regimens that are obsolete, outdated, or of historical interest only.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 neuroblastoma page for current regimens.
2 regimens on this page
2 variants on this page
|
High Risk
COG ANBL0532 Regimen A
Study | Dates of enrollment | Evidence | Comparator | Comparative Efficacy |
---|---|---|---|---|
Park et al. 2019 (COG ANBL0532) | Phase 3 (C) | COG ANBL0532 Regimen B | Inferior EFS |
Induction
Chemotherapy, Cycle 1 (CPM + TOPO)
- Cyclophosphamide (Cytoxan) by the following weight-based criteria:
- ≤ 12 kg: 13.3 mg/kg iV over 30 to 60 minutes once daily on days 1 through 5
- > 12 kg: 400 mg/m2 IV over 30 to 60 minutes once daily on days 1 through 5
- Topotecan (Hycamtin) 1.2 mg/m2 IV over 30 minutes once daily on days 1 through 5
21 Day Cycle
Chemotherapy, Cycle 2 (CPM + TOPO)
- Cyclophosphamide (Cytoxan) by the following weight-based criteria:
- ≤ 12 kg: 13.3 mg/kg iV over 30 to 60 minutes once daily on days 1 through 5
- > 12 kg: 400 mg/m2 IV over 30 to 60 minutes once daily on days 1 through 5
- Topotecan (Hycamtin) 1.2 mg/m2 IV over 30 minutes once daily on days 1 through 5
21 Day Cycle
Supportive Therapy, Cycle 2
- Filgrastim (Neupogen) 5 mcg/kg SubQ or IV once daily on Day 6 beginning 24 hours after completion of chemotherapy and continuing until ANC > 1000/μL
- Filgrastim (Neupogen) 10 mcg/kg SubQ or IV once daily beginning once ANC > 1000/μL and continuing until PBSC harvest is complete
- PBSC harvest on day 14
21 Day Cycle
Chemotherapy, Cycle 3 (CDDP + ETOP)
- Cisplatin (Platinol) by the following weight-based criteria:
- ≤ 12 kg: 1.66 mg/kg IV over 1 hour once daily on days 1 through 4
- > 12 kg: 50 mg/m2 IV over 1 hour once daily on days 1 through 4
- Etoposide (Vepesid) by the following weight-based criteria:
- ≤ 12 kg: 6.67 mg/kg IV over 1 hour once daily on days 1 through 3
- > 12 kg: 200 mg/m2 IV over 1 hour once daily on days 1 through 3
Chemotherapy, Cycle 4 (CPM + DOXO + VCR)
- Cyclophosphamide (Cytoxan) by the following weight-based criteria:
- ≤ 12 kg: 70 mg/kg iV over 6 hours once daily on days 1 through 2
- > 12 kg: 2100 mg/m2 IV over 6 hours once daily on days 1 through 2
- Vincristine (Oncovin) by the following criteria:
- < 12 months: 0.017 mg/kg (Max Dose of 2 mg in 72 hours) IV over 1 minute or infusion (per institutional policy) once daily before Doxorubicin (Adriamycin) on days 1 through 3
- ≥ 12 months and > 12 kg: 0.097 mg/m2 or 0.022 mg/kg (choose lower dose) (Max Dose of 2 mg in 72 hours) IV over 1 minute or infusion (per institutional policy) once daily before Doxorubicin (Adriamycin) on days 1 through 3
- ≥ 12 months and ≤ 12 kg: 0.022 mg/kg (Max Dose of 2 mg in 72 hours) IV over 1 minute or infusion (per institutional policy) once daily before Doxorubicin (Adriamycin) on days 1 through 3
- Doxorubicin (Adriamycin) by the following weight-based criteria:
- ≤ 12 kg: 0.83 mg/kg iV over 24 hours once daily on days 1 through 3
- > 12 kg: 25 mg/m2 IV over 24 hours once daily on days 1 through 3
21 Day Cycle
Supportive Therapy, Cycle 4 (CPM + DOXO + VCR)
- Mesna (Mesnex) by the following weight-based criteria:
- ≤ 12 kg: 14 mg/kg IV over 15 minutes immediately prior to each Cyclophosphamide (Cytoxan) dose and again at 4 and 8 hours after eachCyclophosphamide (Cytoxan) infusion
- > 12 kg: 420 mg/m2 IV over 15 minutes immediately prior to each Cyclophosphamide (Cytoxan) dose and again at 4 and 8 hours after eachCyclophosphamide (Cytoxan) infusion
21 Day Cycle
Chemotherapy, Cycle 5 (CDDP + ETOP)
- Cisplatin (Platinol) by the following weight-based criteria:
- ≤ 12 kg: 1.66 mg/kg IV over 1 hour once daily on days 1 through 4
- > 12 kg: 50 mg/m2 IV over 1 hour once daily on days 1 through 4
- Etoposide (Vepesid) by the following weight-based criteria:
- ≤ 12 kg: 6.67 mg/kg IV over 1 hour once daily on days 1 through 3
- > 12 kg: 200 mg/m2 IV over 1 hour once daily on days 1 through 3
21 Day Cycle
Chemotherapy, Cycle 6 (CPM + DOXO + VCR)
- Cyclophosphamide (Cytoxan) by the following weight-based criteria:
- ≤ 12 kg: 70 mg/kg iV over 6 hours once daily on days 1 through 2
- > 12 kg: 2100 mg/m2 IV over 6 hours once daily on days 1 through 2
- Vincristine (Oncovin) by the following criteria:
- < 12 months: 0.017 mg/kg (Max Dose of 2 mg in 72 hours) IV over 1 minute or infusion (per institutional policy) once daily before Doxorubicin (Adriamycin) on days 1 through 3
- ≥ 12 months and > 12 kg: 0.097 mg/m2 or 0.022 mg/kg (choose lower dose) (Max Dose of 2 mg in 72 hours) IV over 1 minute or infusion (per institutional policy) once daily before Doxorubicin (Adriamycin) on days 1 through 3
- ≥ 12 months and ≤ 12 kg: 0.022 mg/kg (Max Dose of 2 mg in 72 hours) IV over 1 minute or infusion (per institutional policy) once daily before Doxorubicin (Adriamycin) on days 1 through 3
- Doxorubicin (Adriamycin) by the following weight-based criteria:
- ≤ 12 kg: 0.83 mg/kg iV over 24 hours once daily on days 1 through 3
- > 12 kg: 25 mg/m2 IV over 24 hours once daily on days 1 through 3
21 Day Cycle
Supportive Therapy, Cycle 6 (CPM + DOXO + VCR)
- Mesna (Mesnex) by the following weight-based criteria:
- ≤ 12 kg: 14 mg/kg IV over 15 minutes immediately prior to each Cyclophosphamide (Cytoxan) dose and again at 4 and 8 hours after eachCyclophosphamide (Cytoxan) infusion
- > 12 kg: 420 mg/m2 IV over 15 minutes immediately prior to each Cyclophosphamide (Cytoxan) dose and again at 4 and 8 hours after eachCyclophosphamide (Cytoxan) infusion
21 Day Cycle
Consolidation, single autologous HSCT
Chemotherapy, High Dose with PBSC Support
- Melphalan (Alkeran) by the following criteria:
- ≤ 12 kg and GFR ≥ 100 mL/min: 2.3 mg/kg IV over 15 to 30 minutes once daily on days -7, -6, -5
- > 12 kg and GFR ≥ 100 mL/min: 70 mg/m2 IV over 15 to 30 minutes once daily on days -7, -6, -5
- ≤ 12 kg and GFR between 100 mL/min and 60 mL/min: 2 mg/kg IV over 15 to 30 minutes once daily on days -7, -6, -5
- > 12 kg and GFR between 100 mL/min and 60 mL/min: 60 mg/m2 IV over 15 to 30 minutes once daily on days -7, -6, -5
- Etoposide (Vepesid) by the following criteria:
- ≤ 12 kg and GFR ≥ 100 mL/min: 11.3 mg/kg IV over 24 hours once daily on days -7, -6, -5, -4
- > 12 kg and GFR ≥ 100 mL/min: 338 mg/m2 IV over 24 hours once daily on days -7, -6, -5, -4
- ≤ 12 kg and GFR between 100 mL/min and 60 mL/min: 6.7 mg/kg IV over 24 hours once daily on days -7, -6, -5, -4
- > 12 kg and GFR between 100 mL/min and 60 mL/min: 200 mg/m2 IV over 24 hours once daily on days -7, -6, -5, -4
- Carboplatin (Paraplatin) by the following criteria:
- ≤ 12 kg and GFR ≥ 100 mL/min: 14.2 mg/kg IV over 24 hours once daily on days -7, -6, -5, -4
- > 12 kg and GFR ≥ 100 mL/min: 425 mg/m2 IV over 24 hours once daily on days -7, -6, -5, -4
- ≤ 12 kg and GFR between 100 mL/min and 60 mL/min: 4.1 AUC using Calvert Formula (Max Dose = 300 mg/m2) IV over 24 hours once daily on days -7, -6, -5, -4
- > 12 kg and GFR between 100 mL/min and 60 mL/min: Use the lowest of either 4.1 AUC using Calvert Formula or 10 mg/kg IV over 24 hours once daily on days -7, -6, -5, -4
- PBSC on day 0
36 Day Cycle
Supportive therapy,
- Filgrastim (Neupogen) 5 mcg/kg SubQ or IV once daily starting on day 0 and continuing until post-nadir ANC > 2000/μL for 3 consecutive days
36 Day Cycle
Maintenance
Chemotherapy
- Isotretinoin (Accutane) by the following weight-based criteria:
- ≤ 12 kg: 5.33 mg/kg (Round dose to nearest 10 mg) PO twice per day on days 1 through 14
- > 12 kg: 160 mg/m2 (Round dose to nearest 10 mg) PO twice per day on days 1 through 14
28-day cycle for 6 cycles
References
- COG ANBL0532: Park JR, Kreissman SG, London WB, Naranjo A, Cohn SL, Hogarty MD, Tenney SC, Haas-Kogan D, Shaw PJ, Kraveka JM, Roberts SS, Geiger JD, Doski JJ, Voss SD, Maris JM, Grupp SA, Diller L. Effect of Tandem Autologous Stem Cell Transplant vs Single Transplant on Event-Free Survival in Patients With High-Risk Neuroblastoma: A Randomized Clinical Trial. JAMA. 2019 Aug 27;322(8):746-755. link to original article link to PMC article PubMed NCT00567567
COG ANBL 0032 Regimen A
Post-consolidation, Study Phase
Study | Dates of enrollment | Evidence |
---|---|---|
Yu et al. 2010 (COG ANBL0032) | 2001-2009 | Non-randomized portion of phase 3 RCT |
Chemotherapy
- Isotretinoin (Accutane) by the following weight-based criteria:
- > 12 kg: 80 mg/m2 (Round to nearest 10 mg) PO twice per day on days 11 through 24
- ≤ 12 kg: 2.67 mg/kg (Round to nearest 10 mg) PO twice per day on days 11 through 24
25-day cycle for 6 cycles
References
- COG ANBL0032: Yu AL, Gilman AL, Ozkaynak MF, London WB, Kreissman SG, Chen HX, Smith M, Anderson B, Villablanca JG, Matthay KK, Shimada H, Grupp SA, Seeger R, Reynolds CP, Buxton A, Reisfeld RA, Gillies SD, Cohn SL, Maris JM, Sondel PM; Children's Oncology Group. Anti-GD2 antibody with GM-CSF, interleukin-2, and isotretinoin for neuroblastoma. N Engl J Med. 2010 Sep 30;363(14):1324-34. link to original article link to PMC article PubMed NCT00026312
- Update: Yu AL, Gilman AL, Ozkaynak MF, Naranjo A, Diccianni MB, Gan J, Hank JA, Batova A, London WB, Tenney SC, Smith M, Shulkin BL, Parisi M, Matthay KK, Cohn SL, Maris JM, Bagatell R, Park JR, Sondel PM. Long-Term Follow-up of a Phase III Study of ch14.18 (Dinutuximab) + Cytokine Immunotherapy in Children with High-Risk Neuroblastoma: COG Study ANBL0032. Clin Cancer Res. 2021 Apr 15;27(8):2179-2189. Epub 2021 Jan 27. link to original article link to PMC article PubMed
COG A3973 with Myeloablative Therapy
Study | Dates of enrollment | Evidence |
---|---|---|
Kreissman et al. 2013 (COG A3973) | 2001-2006 | Non-randomized portion of phase 3 RCT |
Induction
Chemotherapy, Cycles 1, 2, 4, and 6
- Vincristine (Oncovin) by the following criteria:
- < 12 months: 0.017 mg/kg (Max Dose of 2 mg in 72 hours) IV over 1 minute or infusion (per institutional policy) once daily before Doxorubicin (Adriamycin) on days 0 through 2
- ≥ 12 months and > 12 kg: 0.67 mg/m2 or 0.022 mg/kg (choose lower dose) (Max Dose of 2 mg/m2 in 72 hours) IV over 1 minute or infusion (per institutional policy) once daily before Doxorubicin (Adriamycin) on days 0 through 2
- ≥ 12 months and ≤ 12 kg: 0.022 mg/kg (Max Dose of 2 mg in 72 hours) IV over 1 minute or infusion (per institutional policy) once daily before Doxorubicin (Adriamycin) on days 0 through 2
- Cyclophosphamide (Cytoxan) by the following weight-based criteria:
- ≤ 12 kg: 70 mg/kg IV over 6 hours once daily on days 0, 1
- > 12 kg: 2100 mg/m2 IV over 6 hours once daily on days 0, 1
- Doxorubicin (Adriamycin) by the following weight-based criteria:
- ≤ 12 kg: 0.83 mg/kg IV over 24 hours once daily on days 0 through 2
- > 12 kg: 25 mg/m2 IV over 24 hours once daily on days 0 through 2
21-Day Cycles PBSC Harvest occurs on Week 6 of treatment (Cycle 2)
Supportive therapy, Cycle 1, 2, 4, and 6
- Mesna (Mesnex) by the following weight-based criteria:
- ≤ 12 kg: 10 mg/kg IV over 15 minutes immediately prior to each Cyclophosphamide (Cytoxan) dose and again at 4 and 8 hours after each Cyclophosphamide (Cytoxan) infusion on days 0, 1
- > 12 kg: 420 mg/m2 IV over 15 minutes immediately prior to each Cyclophosphamide (Cytoxan) dose and again at 3, 6, and 9 hours after each Cyclophosphamide (Cytoxan) infusion on days 0, 1
- Filgrastim (Neupogen) 5 mcg/kg SubQ or IV once daily starting on day 3 and continuing until post-nadir ANC > 1500/μL
21-Day Cycles
Chemotherapy, Cycles 3 and 5
- Cisplatin (Platinol) by the following weight-based criteria:
- ≤ 12 kg: 1.66 mg/kg IV over 1 hour once daily on days 0 through 3
- > 12 kg: 50 mg/m2 IV over 1 hour once daily on days 0 through 3
- Etoposide (Vepesid) by the following weight-based criteria:
- ≤ 12 kg: 6.67 mg/kg IV over 2 hours once daily on days 0 through 2
- > 12 kg: 200 mg/m2 IV over 2 hours once daily on days 0 through 2
21-Day Cycles
Supportive therapy, Cycles 3 and 5
- Filgrastim (Neupogen) 5 mcg/kg SubQ or IV once daily starting on day 4 and continuing until post-nadir ANC > 1500/μL
21-Day Cycles
Consolidation
Chemotherapy
- Carboplatin (Paraplatin) by the following criteria:
- ≤ 12 kg and GFR ≥ 100 mL/min: 14.2 mg/kg IV over 24 hours once daily on days -7, -6, -5, -4
- > 12 kg and GFR ≥ 100 mL/min: 425 mg/m2 IV over 24 hours once daily on days -7, -6, -5, -4
- ≤ 12 kg and GFR between 100 mL/min and 60 mL/min: Use the lowest of either 4.1 AUC using Calvert Formula or 10 mg/kg IV over 24 hours once daily on days -7, -6, -5, -4
- > 12 kg and GFR between 100 mL/min and 60 mL/min: 4.1 AUC using Calvert Formula (Max Dose = 300 mg/m2) IV over 24 hours once daily on days -7, -6, -5, -4
- Etoposide (Vepesid) by the following criteria:
- ≤ 12 kg and GFR ≥ 100 mL/min: 11.3 mg/kg IV over 24 hours once daily on days -7, -6, -5, -4
- > 12 kg and GFR ≥ 100 mL/min: 338 mg/m2 IV over 24 hours once daily on days -7, -6, -5, -4
- ≤ 12 kg and GFR between 100 mL/min and 60 mL/min: 6.7 mg/kg IV over 24 hours once daily on days -7, -6, -5, -4
- > 12 kg and GFR between 100 mL/min and 60 mL/min: 200 mg/m2 IV over 24 hours once daily on days -7, -6, -5, -4
- Melphalan (Alkeran) by the following criteria:
- ≤ 12 kg and GFR ≥ 100 mL/min: 2.3 mg/kg IV over 15 to 30 minutes once daily on days -7, -6, -5
- > 12 kg and GFR ≥ 100 mL/min: 70 mg/m2 IV over 15 to 30 minutes once daily on days -7, -6, -5
- ≤ 12 kg and GFR between 100 mL/min and 60 mL/min: 2 mg/kg IV over 15 to 30 minutes once daily on days -7, -6, -5
- > 12 kg and GFR between 100 mL/min and 60 mL/min: 60 mg/m2 IV over 15 to 30 minutes once daily on days -7, -6, -5
- PBSC on day 0
Maintenance, "Post Consolidation" Isotretinoin
Chemotherapy
- Isotretinoin (Accutane) by the following weight-based criteria:
- ≤ 12 kg: 5.33 mg/kg (Round dose to nearest 10 mg) PO twice per day on days 1 through 14
- > 12 kg: 160 mg/m2 (Round dose to nearest 10 mg) PO twice per day on days 1 through 14
28-day cycle for 6 cycles
References
- COG A3973: Kreissman SG, Seeger RC, Matthay KK, London WB, Sposto R, Grupp SA, Haas-Kogan DA, Laquaglia MP, Yu AL, Diller L, Buxton A, Park JR, Cohn SL, Maris JM, Reynolds CP, Villablanca JG. Purged versus non-purged peripheral blood stem-cell transplantation for high-risk neuroblastoma (COG A3973): a randomised phase 3 trial. Lancet Oncol. 2013 Sep;14(10):999-1008. Epub 2013 Jul 25. link to original article link to PMC article PubMed NCT00004188
- Subgroup analysis: von Allmen D, Davidoff AM, London WB, Van Ryn C, Haas-Kogan DA, Kreissman SG, Khanna G, Rosen N, Park JR, La Quaglia MP. Impact of Extent of Resection on Local Control and Survival in Patients from the COG A3973 Study with High-Risk Neuroblastoma. J Clin Oncol. 2017 Jan 35;2:208-216 link to original article link to PMC article link to PubMed
COG A3973 without Myeloablative Therapy
Study | Dates of enrollment | Evidence |
---|---|---|
Kreissman et al. 2013 (COG A3973) | 2001-2006 | Non-randomized portion of phase 3 RCT |
Induction
Chemotherapy, Cycles 1, 2, 4, and 6
- Vincristine (Oncovin) by the following criteria:
- < 12 months: 0.017 mg/kg (Max Dose of 2 mg in 72 hours) IV over 1 minute or infusion (per institutional policy) once daily before Doxorubicin (Adriamycin) on days 0 through 2
- ≥ 12 months and > 12 kg: 0.67 mg/m2 or 0.022 mg/kg (choose lower dose) (Max Dose of 2 mg/m2 in 72 hours) IV over 1 minute or infusion (per institutional policy) once daily before Doxorubicin (Adriamycin) on days 0 through 2
- ≥ 12 months and ≤ 12 kg: 0.022 mg/kg (Max Dose of 2 mg in 72 hours) IV over 1 minute or infusion (per institutional policy) once daily before Doxorubicin (Adriamycin) on days 0 through 2
- Cyclophosphamide (Cytoxan) by the following weight-based criteria:
- ≤ 12 kg: 70 mg/kg IV over 6 hours once daily on days 0, 1
- > 12 kg: 2100 mg/m2 IV over 6 hours once daily on days 0, 1
- Doxorubicin (Adriamycin) by the following weight-based criteria:
- ≤ 12 kg: 0.83 mg/kg IV over 24 hours once daily on days 0 through 2
- > 12 kg: 25 mg/m2 IV over 24 hours once daily on days 0 through 2
21-day Cycles PBSC Harvest occurs on Week 6 of treatment (Cycle 2)
Supportive therapy, Cycle 1, 2, 4, and 6
- Mesna (Mesnex) by the following weight-based criteria:
- ≤ 12 kg: 10 mg/kg IV over 15 minutes immediately prior to each Cyclophosphamide (Cytoxan) dose and again at 4 and 8 hours after each Cyclophosphamide (Cytoxan) infusion on days 0, 1
- > 12 kg: 420 mg/m2 IV over 15 minutes immediately prior to each Cyclophosphamide (Cytoxan) dose and again at 3, 6, and 9 hours after each Cyclophosphamide (Cytoxan) infusion on days 0, 1
- Filgrastim (Neupogen) 5 mcg/kg SubQ or IV once daily starting on day 3 and continuing until post-nadir ANC > 1500/μL
21-Day Cycles
Chemotherapy, Cycles 3 and 5
- Cisplatin (Platinol) by the following weight-based criteria:
- ≤ 12 kg: 1.66 mg/kg IV over 1 hour once daily on days 0 through 3
- > 12 kg: 50 mg/m2 IV over 1 hour once daily on days 0 through 3
- Etoposide (Vepesid) by the following weight-based criteria:
- ≤ 12 kg: 6.67 mg/kg IV over 2 hours once daily on days 0 through 2
- > 12 kg: 200 mg/m2 IV over 2 hours once daily on days 0 through 2
21-Day Cycles
Supportive therapy, Cycles 3 and 5
- Filgrastim (Neupogen) 5 mcg/kg SubQ or IV once daily starting on day 4 and continuing until post-nadir ANC > 1500/μL
21-Day Cycles
Maintenance, Cyclophosphamide and Topotecan
Chemotherapy, 3 cycles
- Cyclophosphamide (Cytoxan) by the following weight-based criteria:
- ≤ 12 kg: 8.33 mg/kg IV over 30 minutes once daily on days 0 through 4
- > 12 kg: 250 mg/m2 IV over 30 minutes once daily on days 0 through 4
- Topotecan (Hycamtin) by the following weight-based criteria:
- ≤ 12 kg: 0.025 mg/kg IV over 30 minutes once daily on days 0 through 4
- > 12 kg: 0.75 mg/m2 IV over 30 minutes once daily on days 0 through 4
21 Day Cycle
Supportive therapy, 3 cycles
- Mesna (Mesnex) by the following weight-based criteria:
- ≤ 12 kg: 1.7 mg/kg IV over 15 minutes immediately prior to each Cyclophosphamide (Cytoxan) dose and again at 4 and 8 hours after each Cyclophosphamide (Cytoxan) infusion on days 0, 1
- > 12 kg: 50 mg/m2 IV over 15 minutes immediately prior to each Cyclophosphamide (Cytoxan) dose and again 3 hours after each Cyclophosphamide (Cytoxan) infusion on days 0, 1
- Filgrastim (Neupogen) 5 mcg/kg SubQ or IV once daily starting on day 5 and continuing until post-nadir ANC > 1500/μL
21-Day Cycles
Maintenance, "Post Maintenance" Isotretinoin
Chemotherapy, 6 cycles
- Isotretinoin (Accutane) by the following weight-based criteria:
- ≤ 12 kg: 5.33 mg/kg (Round dose to nearest 10 mg) PO twice per day on days 1 through 14
- > 12 kg: 160 mg/m2 (Round dose to nearest 10 mg) PO twice per day on days 1 through 14
28 Day Cycle
References
- COG A3973: Kreissman SG, Seeger RC, Matthay KK, London WB, Sposto R, Grupp SA, Haas-Kogan DA, Laquaglia MP, Yu AL, Diller L, Buxton A, Park JR, Cohn SL, Maris JM, Reynolds CP, Villablanca JG. Purged versus non-purged peripheral blood stem-cell transplantation for high-risk neuroblastoma (COG A3973): a randomised phase 3 trial. Lancet Oncol. 2013 Sep;14(10):999-1008. Epub 2013 Jul 25. link to original article link to PMC article PubMed NCT00004188
- Subgroup analysis: von Allmen D, Davidoff AM, London WB, Van Ryn C, Haas-Kogan DA, Kreissman SG, Khanna G, Rosen N, Park JR, La Quaglia MP. Impact of Extent of Resection on Local Control and Survival in Patients from the COG A3973 Study with High-Risk Neuroblastoma. J Clin Oncol. 2017 Jan 35;2:208-216 link to original article link to PMC article link to PubMed
Relapsed or refractory
Cyclophosphamide monotherapy
References
- Thurman WG, Fernbach DJ, Sullivan MP. Cyclophosphamide therapy in childhood neuroblastoma. N Engl J Med. 1964 Jun 18;270:1336-40. link to original article PubMed
Cyclophosphamide & Vincristine
References
- Evans AE, Heyn RM, Newton WA Jr, Leikin SL. Vincristine sulfate and cyclophosphamide for children with metastatic neuroblastoma. JAMA. 1969 Feb 17;207(7):1325-7. link to original article PubMed