Rhabdomyosarcoma, pediatric
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Intermediate Risk
COG ARST1431
Regimen A (VAC/VI Only)
Cycles 1-4 (Weeks 1 through 12)
Chemotherapy
- Vincristine (Oncovin) by the following BSA-based criteria:
- 0.25-0.29 m2 BSA: 0.24 mg IV push over 1 minute (or infusion via minibag as per institutional policy once weekly on day 1 of weeks 1 through 12
- 0.3-0.34 m2 BSA: 0.34 mg IV push over 1 minute (or infusion via minibag as per institutional policy once weekly on day 1 of weeks 1 through 12
- 0.35-0.39 m2 BSA: 0.44 mg IV push over 1 minute (or infusion via minibag as per institutional policy once weekly on day 1 of weeks 1 through 12
- 0.4-0.44 m2 BSA: 0.55 mg IV push over 1 minute (or infusion via minibag as per institutional policy once weekly on day 1 of weeks 1 through 12
- 0.45-0.49 m2 BSA: 0.65 mg IV push over 1 minute (or infusion via minibag as per institutional policy once weekly on day 1 of weeks 1 through 12
- 0.5-0.54 m2 BSA: 0.74 mg IV push over 1 minute (or infusion via minibag as per institutional policy once weekly on day 1 of weeks 1 through 12
- 0.55-0.59 m2 BSA: 0.8 mg IV push over 1 minute (or infusion via minibag as per institutional policy once weekly on day 1 of weeks 1 through 12
- ≥ 0.6 m2 BSA: 1.5 mg/m2 (maximum dose of 2 mg) IV push over 1 minute (or infusion via minibag as per institutional policy once weekly on day 1 of weeks 1 through 12
- Dactinomycin (Cosmegen) by the following weight-based criteria:
- 3-4.5 kg: 0.09 mg slow IV push over 1 to 5 minutes or IV infusion over 10 to 15 minutes on day 1 of weeks 1 and 7
- 4.6-6 kg: 0.14 mg slow IV push over 1 to 5 minutes or IV infusion over 10 to 15 minutes on day 1 of weeks 1 and 7
- 6.1-7.3 kg: 0.21 mg slow IV push over 1 to 5 minutes or IV infusion over 10 to 15 minutes on day 1 of weeks 1 and 7
- 7.4-8.6 kg: 0.26 mg slow IV push over 1 to 5 minutes or IV infusion over 10 to 15 minutes on day 1 of weeks 1 and 7
- 8.7-9.9 kg: 0.33 mg slow IV push over 1 to 5 minutes or IV infusion over 10 to 15 minutes on day 1 of weeks 1 and 7
- 10-11.2 kg: 0.4 mg slow IV push over 1 to 5 minutes or IV infusion over 10 to 15 minutes on day 1 of weeks 1 and 7
- 11.3-12.5 kg: 0.5 mg slow IV push over 1 to 5 minutes or IV infusion over 10 to 15 minutes on day 1 of weeks 1 and 7
- 12.6-13.9 kg: 0.6 mg slow IV push over 1 to 5 minutes or IV infusion over 10 to 15 minutes on day 1 of weeks 1 and 7
- ≥14 kg: 0.05 mg/kg (maximum dose of 2.5 mg) slow IV push over 1 to 5 minutes or IV infusion over 10 to 15 minutes on day 1 of weeks 1 and 7
- Cyclophosphamide (Cytoxan) by the following BSA-based criteria:
- 0.25-0.29 m2 BSA: 220 mg IV over 60 minutes on day 1 of weeks 1 and 7
- 0.3-0.34 m2 BSA: 280 mg IV over 60 minutes on day 1 of weeks 1 and 7
- 0.35-0.39 m2 BSA: 360 mg IV over 60 minutes on day 1 of weeks 1 and 7
- 0.4-0.44 m2 BSA: 440 mg IV over 60 minutes on day 1 of weeks 1 and 7
- 0.45-0.49 m2 BSA: 520 mg IV over 60 minutes on day 1 of weeks 1 and 7
- 0.5-0.54 m2 BSA: 600 mg IV over 60 minutes on day 1 of weeks 1 and 7
- 0.55-0.59 m2 BSA: 660 mg IV over 60 minutes on day 1 of weeks 1 and 7
- ≥ 0.6 m2 BSA: 1200 mg/m2 IV over 60 minutes on day 1 of weeks 1 and 7
- Mesna (Mesnex) by the following BSA-based criteria:
Mesna (Mesnex) can also be given PO at twice the IV dose
- 0.25-0.29 m2 BSA: 176 mg IV over 15 to 30 minutes immediately before Cyclophosphamide (Cytoxan) infusion, and again 4 and 8 hours after the start of Cyclophosphamide (Cytoxan) infusion
- 0.3-0.34 m2 BSA: 224 mg IV over 15 to 30 minutes immediately before Cyclophosphamide (Cytoxan) infusion, and again 4 and 8 hours after the start of Cyclophosphamide (Cytoxan) infusion
- 0.35-0.39 m2 BSA: 288 mg IV over 15 to 30 minutes immediately before Cyclophosphamide (Cytoxan) infusion, and again 4 and 8 hours after the start of Cyclophosphamide (Cytoxan) infusion
- 0.4-0.44 m2 BSA: 352 mg IV over 15 to 30 minutes immediately before Cyclophosphamide (Cytoxan) infusion, and again 4 and 8 hours after the start of Cyclophosphamide (Cytoxan) infusion
- 0.45-0.49 m2 BSA: 416 mg IV over 15 to 30 minutes immediately before Cyclophosphamide (Cytoxan) infusion, and again 4 and 8 hours after the start of Cyclophosphamide (Cytoxan) infusion
- 0.5-0.54 m2 BSA: 480 mg IV over 15 to 30 minutes immediately before Cyclophosphamide (Cytoxan) infusion, and again 4 and 8 hours after the start of Cyclophosphamide (Cytoxan) infusion
- 0.55-0.59 m2 BSA: 528 mg IV over 15 to 30 minutes immediately before Cyclophosphamide (Cytoxan) infusion, and again 4 and 8 hours after the start of Cyclophosphamide (Cytoxan) infusion
- ≥ 0.6 m2 BSA: 960 mg/m2 IV over 15 to 30 minutes immediately before Cyclophosphamide (Cytoxan) infusion, and again 4 and 8 hours after the start of Cyclophosphamide (Cytoxan) infusion
- Irinotecan (Camptosar) by the following BSA-based criteria:
- 0.25-0.29 m2 BSA: 8 mg IV over 90 minutes once daily on days 1 through 5 of weeks 4 and 10
- 0.3-0.34 m2 BSA: 12 mg IV over 90 minutes once daily on days 1 through 5 of weeks 4 and 10
- 0.35-0.39 m2 BSA: 15 mg IV over 90 minutes once daily on days 1 through 5 of weeks 4 and 10
- 0.4-0.44 m2 BSA: 18 mg IV over 90 minutes once daily on days 1 through 5 of weeks 4 and 10
- 0.45-0.49 m2 BSA: 22 mg IV over 90 minutes once daily on days 1 through 5 of weeks 4 and 10
- 0.5-0.54 m2 BSA: 24 mg IV over 90 minutes once daily on days 1 through 5 of weeks 4 and 10
- 0.55-0.59 m2 BSA: 28 mg IV over 90 minutes once daily on days 1 through 5 of weeks 4 and 10
- ≥ 0.6 m2 BSA: 50 mg/m2 IV over 90 minutes once daily on days 1 through 5 of weeks 4 and 10
Cycles 5-10 (Weeks 13 through 30)
Chemotherapy
- Vincristine (Oncovin) by the following BSA-based criteria:
- 0.25-0.29 m2 BSA: 0.24 mg IV push over 1 minute (or infusion via minibag as per institutional policy once weekly on day 1 of weeks 13, 16, 17, 19, 20, 22 through 26, 28
- 0.3-0.34 m2 BSA: 0.34 mg IV push over 1 minute (or infusion via minibag as per institutional policy once weekly on day 1 of weeks 13, 16, 17, 19, 20, 22 through 26, 28
- 0.35-0.39 m2 BSA: 0.44 mg IV push over 1 minute (or infusion via minibag as per institutional policy once weekly on day 1 of weeks 13, 16, 17, 19, 20, 22 through 26, 28
- 0.4-0.44 m2 BSA: 0.55 mg IV push over 1 minute (or infusion via minibag as per institutional policy once weekly on day 1 of weeks 13, 16, 17, 19, 20, 22 through 26, 28
- 0.45-0.49 m2 BSA: 0.65 mg IV push over 1 minute (or infusion via minibag as per institutional policy once weekly on day 1 of weeks 13, 16, 17, 19, 20, 22 through 26, 28
- 0.5-0.54 m2 BSA: 0.74 mg IV push over 1 minute (or infusion via minibag as per institutional policy once weekly on day 1 of weeks 13, 16, 17, 19, 20, 22 through 26, 28
- 0.55-0.59 m2 BSA: 0.8 mg IV push over 1 minute (or infusion via minibag as per institutional policy once weekly on day 1 of weeks 13, 16, 17, 19, 20, 22 through 26, 28
- ≥ 0.6 m2 BSA: 1.5 mg/m2 (maximum dose of 2 mg) IV push over 1 minute (or infusion via minibag as per institutional policy once weekly on day 1 of weeks 13, 16, 17, 19, 20, 22 through 26, 28
- Dactinomycin (Cosmegen) by the following weight-based criteria:
- 3-4.5 kg: 0.09 mg slow IV push over 1 to 5 minutes or IV infusion over 10 to 15 minutes on day 1 of weeks 13, 22, 28
- 4.6-6 kg: 0.14 mg slow IV push over 1 to 5 minutes or IV infusion over 10 to 15 minutes on day 1 of weeks 13, 22, 28
- 6.1-7.3 kg: 0.21 mg slow IV push over 1 to 5 minutes or IV infusion over 10 to 15 minutes on day 1 of weeks 13, 22, 28
- 7.4-8.6 kg: 0.26 mg slow IV push over 1 to 5 minutes or IV infusion over 10 to 15 minutes on day 1 of weeks 13, 22, 28
- 8.7-9.9 kg: 0.33 mg slow IV push over 1 to 5 minutes or IV infusion over 10 to 15 minutes on day 1 of weeks 13, 22, 28
- 10-11.2 kg: 0.4 mg slow IV push over 1 to 5 minutes or IV infusion over 10 to 15 minutes on day 1 of weeks 13, 22, 28
- 11.3-12.5 kg: 0.5 mg slow IV push over 1 to 5 minutes or IV infusion over 10 to 15 minutes on day 1 of weeks 13, 22, 28
- 12.6-13.9 kg: 0.6 mg slow IV push over 1 to 5 minutes or IV infusion over 10 to 15 minutes on day 1 of weeks 13, 22, 28
- ≥14 kg: 0.05 mg/kg (maximum dose of 2.5 mg) slow IV push over 1 to 5 minutes or IV infusion over 10 to 15 minutes on day 1 of weeks 13, 22, 28
- Cyclophosphamide (Cytoxan) by the following BSA-based criteria:
- 0.25-0.29 m2 BSA: 220 mg IV over 60 minutes on day 1 of weeks 13, 22, 28
- 0.3-0.34 m2 BSA: 280 mg IV over 60 minutes on day 1 of weeks 13, 22, 28
- 0.35-0.39 m2 BSA: 360 mg IV over 60 minutes on day 1 of weeks 13, 22, 28
- 0.4-0.44 m2 BSA: 440 mg IV over 60 minutes on day 1 of weeks 13, 22, 28
- 0.45-0.49 m2 BSA: 520 mg IV over 60 minutes on day 1 of weeks 13, 22, 28
- 0.5-0.54 m2 BSA: 600 mg IV over 60 minutes on day 1 of weeks 13, 22, 28
- 0.55-0.59 m2 BSA: 660 mg IV over 60 minutes on day 1 of weeks 13, 22, 28
- ≥ 0.6 m2 BSA: 1200 mg/m2 IV over 60 minutes on day 1 of weeks 13, 22, 28
- Mesna (Mesnex) by the following BSA-based criteria:
Mesna (Mesnex) can also be given PO at twice the IV dose
- 0.25-0.29 m2 BSA: 176 mg IV over 15 to 30 minutes immediately before Cyclophosphamide (Cytoxan) infusion, and again 4 and 8 hours after the start of Cyclophosphamide (Cytoxan) infusion
- 0.3-0.34 m2 BSA: 224 mg IV over 15 to 30 minutes immediately before Cyclophosphamide (Cytoxan) infusion, and again 4 and 8 hours after the start of Cyclophosphamide (Cytoxan) infusion
- 0.35-0.39 m2 BSA: 288 mg IV over 15 to 30 minutes immediately before Cyclophosphamide (Cytoxan) infusion, and again 4 and 8 hours after the start of Cyclophosphamide (Cytoxan) infusion
- 0.4-0.44 m2 BSA: 352 mg IV over 15 to 30 minutes immediately before Cyclophosphamide (Cytoxan) infusion, and again 4 and 8 hours after the start of Cyclophosphamide (Cytoxan) infusion
- 0.45-0.49 m2 BSA: 416 mg IV over 15 to 30 minutes immediately before Cyclophosphamide (Cytoxan) infusion, and again 4 and 8 hours after the start of Cyclophosphamide (Cytoxan) infusion
- 0.5-0.54 m2 BSA: 480 mg IV over 15 to 30 minutes immediately before Cyclophosphamide (Cytoxan) infusion, and again 4 and 8 hours after the start of Cyclophosphamide (Cytoxan) infusion
- 0.55-0.59 m2 BSA: 528 mg IV over 15 to 30 minutes immediately before Cyclophosphamide (Cytoxan) infusion, and again 4 and 8 hours after the start of Cyclophosphamide (Cytoxan) infusion
- ≥ 0.6 m2 BSA: 960 mg/m2 IV over 15 to 30 minutes immediately before Cyclophosphamide (Cytoxan) infusion, and again 4 and 8 hours after the start of Cyclophosphamide (Cytoxan) infusion
- Irinotecan (Camptosar) by the following BSA-based criteria:
- 0.25-0.29 m2 BSA: 8 mg IV over 90 minutes once daily on days 1 through 5 of weeks 16, 19, 25
- 0.3-0.34 m2 BSA: 12 mg IV over 90 minutes once daily on days 1 through 5 of weeks 16, 19, 25
- 0.35-0.39 m2 BSA: 15 mg IV over 90 minutes once daily on days 1 through 5 of weeks 16, 19, 25
- 0.4-0.44 m2 BSA: 18 mg IV over 90 minutes once daily on days 1 through 5 of weeks 16, 19, 25
- 0.45-0.49 m2 BSA: 22 mg IV over 90 minutes once daily on days 1 through 5 of weeks 16, 19, 25
- 0.5-0.54 m2 BSA: 24 mg IV over 90 minutes once daily on days 1 through 5 of weeks 16, 19, 25
- 0.55-0.59 m2 BSA: 28 mg IV over 90 minutes once daily on days 1 through 5 of weeks 16, 19, 25
- ≥ 0.6 m2 BSA: 50 mg/m2 IV over 90 minutes once daily on days 1 through 5 of weeks 16, 19, 25
Cycles 11-14 (Weeks 31 through 42)
Chemotherapy
- Vincristine (Oncovin) by the following BSA-based criteria:
- 0.25-0.29 m2 BSA: 0.24 mg IV push over 1 minute (or infusion via minibag as per institutional policy once weekly on day 1 of weeks 31 through 34, 37, 38, 40
- 0.3-0.34 m2 BSA: 0.34 mg IV push over 1 minute (or infusion via minibag as per institutional policy once weekly on day 1 of weeks 31 through 34, 37, 38, 40
- 0.35-0.39 m2 BSA: 0.44 mg IV push over 1 minute (or infusion via minibag as per institutional policy once weekly on day 1 of weeks 31 through 34, 37, 38, 40
- 0.4-0.44 m2 BSA: 0.55 mg IV push over 1 minute (or infusion via minibag as per institutional policy once weekly on day 1 of weeks 31 through 34, 37, 38, 40
- 0.45-0.49 m2 BSA: 0.65 mg IV push over 1 minute (or infusion via minibag as per institutional policy once weekly on day 1 of weeks 31 through 34, 37, 38, 40
- 0.5-0.54 m2 BSA: 0.74 mg IV push over 1 minute (or infusion via minibag as per institutional policy once weekly on day 1 of weeks 31 through 34, 37, 38, 40
- 0.55-0.59 m2 BSA: 0.8 mg IV push over 1 minute (or infusion via minibag as per institutional policy once weekly on day 1 of weeks 31 through 34, 37, 38, 40
- ≥ 0.6 m2 BSA: 1.5 mg/m2 (maximum dose of 2 mg) IV push over 1 minute (or infusion via minibag as per institutional policy once weekly on day 1 of weeks 31 through 34, 37, 38, 40
- Dactinomycin (Cosmegen) by the following weight-based criteria:
- 3-4.5 kg: 0.09 mg slow IV push over 1 to 5 minutes or IV infusion over 10 to 15 minutes on day 1 of weeks 34, 40
- 4.6-6 kg: 0.14 mg slow IV push over 1 to 5 minutes or IV infusion over 10 to 15 minutes on day 1 of weeks 34, 40
- 6.1-7.3 kg: 0.21 mg slow IV push over 1 to 5 minutes or IV infusion over 10 to 15 minutes on day 1 of weeks 34, 40
- 7.4-8.6 kg: 0.26 mg slow IV push over 1 to 5 minutes or IV infusion over 10 to 15 minutes on day 1 of weeks 34, 40
- 8.7-9.9 kg: 0.33 mg slow IV push over 1 to 5 minutes or IV infusion over 10 to 15 minutes on day 1 of weeks 34, 40
- 10-11.2 kg: 0.4 mg slow IV push over 1 to 5 minutes or IV infusion over 10 to 15 minutes on day 1 of weeks 34, 40
- 11.3-12.5 kg: 0.5 mg slow IV push over 1 to 5 minutes or IV infusion over 10 to 15 minutes on day 1 of weeks 34, 40
- 12.6-13.9 kg: 0.6 mg slow IV push over 1 to 5 minutes or IV infusion over 10 to 15 minutes on day 1 of weeks 34, 40
- ≥14 kg: 0.05 mg/kg (maximum dose of 2.5 mg) slow IV push over 1 to 5 minutes or IV infusion over 10 to 15 minutes on day 1 of weeks 34, 40
- Cyclophosphamide (Cytoxan) by the following BSA-based criteria:
- 0.25-0.29 m2 BSA: 220 mg IV over 60 minutes on day 1 of weeks 34, 40
- 0.3-0.34 m2 BSA: 280 mg IV over 60 minutes on day 1 of weeks 34, 40
- 0.35-0.39 m2 BSA: 360 mg IV over 60 minutes on day 1 of weeks 34, 40
- 0.4-0.44 m2 BSA: 440 mg IV over 60 minutes on day 1 of weeks 34, 40
- 0.45-0.49 m2 BSA: 520 mg IV over 60 minutes on day 1 of weeks 34, 40
- 0.5-0.54 m2 BSA: 600 mg IV over 60 minutes on day 1 of weeks 34, 40
- 0.55-0.59 m2 BSA: 660 mg IV over 60 minutes on day 1 of weeks 34, 40
- ≥ 0.6 m2 BSA: 1200 mg/m2 IV over 60 minutes on day 1 of weeks 34, 40
- Mesna (Mesnex) by the following BSA-based criteria:
Mesna (Mesnex) can also be given PO at twice the IV dose
- 0.25-0.29 m2 BSA: 176 mg IV over 15 to 30 minutes immediately before Cyclophosphamide (Cytoxan) infusion, and again 4 and 8 hours after the start of Cyclophosphamide (Cytoxan) infusion
- 0.3-0.34 m2 BSA: 224 mg IV over 15 to 30 minutes immediately before Cyclophosphamide (Cytoxan) infusion, and again 4 and 8 hours after the start of Cyclophosphamide (Cytoxan) infusion
- 0.35-0.39 m2 BSA: 288 mg IV over 15 to 30 minutes immediately before Cyclophosphamide (Cytoxan) infusion, and again 4 and 8 hours after the start of Cyclophosphamide (Cytoxan) infusion
- 0.4-0.44 m2 BSA: 352 mg IV over 15 to 30 minutes immediately before Cyclophosphamide (Cytoxan) infusion, and again 4 and 8 hours after the start of Cyclophosphamide (Cytoxan) infusion
- 0.45-0.49 m2 BSA: 416 mg IV over 15 to 30 minutes immediately before Cyclophosphamide (Cytoxan) infusion, and again 4 and 8 hours after the start of Cyclophosphamide (Cytoxan) infusion
- 0.5-0.54 m2 BSA: 480 mg IV over 15 to 30 minutes immediately before Cyclophosphamide (Cytoxan) infusion, and again 4 and 8 hours after the start of Cyclophosphamide (Cytoxan) infusion
- 0.55-0.59 m2 BSA: 528 mg IV over 15 to 30 minutes immediately before Cyclophosphamide (Cytoxan) infusion, and again 4 and 8 hours after the start of Cyclophosphamide (Cytoxan) infusion
- ≥ 0.6 m2 BSA: 960 mg/m2 IV over 15 to 30 minutes immediately before Cyclophosphamide (Cytoxan) infusion, and again 4 and 8 hours after the start of Cyclophosphamide (Cytoxan) infusion
- Irinotecan (Camptosar) by the following BSA-based criteria:
- 0.25-0.29 m2 BSA: 8 mg IV over 90 minutes once daily on days 1 through 5 of weeks 31, 37
- 0.3-0.34 m2 BSA: 12 mg IV over 90 minutes once daily on days 1 through 5 of weeks 31, 37
- 0.35-0.39 m2 BSA: 15 mg IV over 90 minutes once daily on days 1 through 5 of weeks 31, 37
- 0.4-0.44 m2 BSA: 18 mg IV over 90 minutes once daily on days 1 through 5 of weeks 31, 37
- 0.45-0.49 m2 BSA: 22 mg IV over 90 minutes once daily on days 1 through 5 of weeks 31, 37
- 0.5-0.54 m2 BSA: 24 mg IV over 90 minutes once daily on days 1 through 5 of weeks 31, 37
- 0.55-0.59 m2 BSA: 28 mg IV over 90 minutes once daily on days 1 through 5 of weeks 31, 37
- ≥ 0.6 m2 BSA: 50 mg/m2 IV over 90 minutes once daily on days 1 through 5 of weeks 31, 37
Maintenance Cycles 1-6
Chemotherapy
- Vinorelbine (Navelbine) by the following BSA-based criteria:
- 0.25-0.29 m2 BSA: 4 mg IV push over 6 to 10 minutes on days 1, 8, and 15
- 0.3-0.34 m2 BSA: 6 mg IV push over 6 to 10 minutes on days 1, 8, and 15
- 0.35-0.39 m2 BSA: 7.5 mg IV push over 6 to 10 minutes on days 1, 8, and 15
- 0.4-0.44 m2 BSA: 9 mg IV push over 6 to 10 minutes on days 1, 8, and 15
- 0.45-0.49 m2 BSA: 11 mg IV push over 6 to 10 minutes on days 1, 8, and 15
- 0.5-0.54 m2 BSA: 12 mg IV push over 6 to 10 minutes on days 1, 8, and 15
- 0.55-0.59 m2 BSA: 14 mg IV push over 6 to 10 minutes on days 1, 8, and 15
- ≥ 0.6 m2 BSA: 25 mg/m2 IV push over 6 to 10 minutes on days 1, 8, and 15
- Cyclophosphamide (Cytoxan) 25 mg/m2 PO once daily on days 1 through 28
- Dose rounded to the nearest 25 mg capsule
28 day cycle
Regimen B (VAC/VI Plus TORI)
Cycles 1-4 (Weeks 1 through 12)
Chemotherapy
- Temsirolimus (Torisel) by the following weight-based criteria:
- < 10 kg: 0.5 mg/kg IV over 30 to 60 minutes once weekly on day 1 of weeks 1 through 12
- > 10 kg: 15 mg/m2 (maximum dose of 25 mg) IV on day 1 of weeks 1 through 12
- Vincristine (Oncovin) by the following BSA-based criteria:
- 0.25-0.29 m2 BSA: 0.24 mg IV push over 1 minute (or infusion via minibag as per institutional policy once weekly on day 1 of weeks 1 through 12
- 0.3-0.34 m2 BSA: 0.34 mg IV push over 1 minute (or infusion via minibag as per institutional policy once weekly on day 1 of weeks 1 through 12
- 0.35-0.39 m2 BSA: 0.44 mg IV push over 1 minute (or infusion via minibag as per institutional policy once weekly on day 1 of weeks 1 through 12
- 0.4-0.44 m2 BSA: 0.55 mg IV push over 1 minute (or infusion via minibag as per institutional policy once weekly on day 1 of weeks 1 through 12
- 0.45-0.49 m2 BSA: 0.65 mg IV push over 1 minute (or infusion via minibag as per institutional policy once weekly on day 1 of weeks 1 through 12
- 0.5-0.54 m2 BSA: 0.74 mg IV push over 1 minute (or infusion via minibag as per institutional policy once weekly on day 1 of weeks 1 through 12
- 0.55-0.59 m2 BSA: 0.8 mg IV push over 1 minute (or infusion via minibag as per institutional policy once weekly on day 1 of weeks 1 through 12
- ≥ 0.6 m2 BSA: 1.5 mg/m2 (maximum dose of 2 mg) IV push over 1 minute (or infusion via minibag as per institutional policy once weekly on day 1 of weeks 1 through 12
- Dactinomycin (Cosmegen) by the following weight-based criteria:
- 3-4.5 kg: 0.09 mg slow IV push over 1 to 5 minutes or IV infusion over 10 to 15 minutes on day 1 of weeks 1 and 7
- 4.6-6 kg: 0.14 mg slow IV push over 1 to 5 minutes or IV infusion over 10 to 15 minutes on day 1 of weeks 1 and 7
- 6.1-7.3 kg: 0.21 mg slow IV push over 1 to 5 minutes or IV infusion over 10 to 15 minutes on day 1 of weeks 1 and 7
- 7.4-8.6 kg: 0.26 mg slow IV push over 1 to 5 minutes or IV infusion over 10 to 15 minutes on day 1 of weeks 1 and 7
- 8.7-9.9 kg: 0.33 mg slow IV push over 1 to 5 minutes or IV infusion over 10 to 15 minutes on day 1 of weeks 1 and 7
- 10-11.2 kg: 0.4 mg slow IV push over 1 to 5 minutes or IV infusion over 10 to 15 minutes on day 1 of weeks 1 and 7
- 11.3-12.5 kg: 0.5 mg slow IV push over 1 to 5 minutes or IV infusion over 10 to 15 minutes on day 1 of weeks 1 and 7
- 12.6-13.9 kg: 0.6 mg slow IV push over 1 to 5 minutes or IV infusion over 10 to 15 minutes on day 1 of weeks 1 and 7
- ≥14 kg: 0.05 mg/kg (maximum dose of 2.5 mg) slow IV push over 1 to 5 minutes or IV infusion over 10 to 15 minutes on day 1 of weeks 1 and 7
- Cyclophosphamide (Cytoxan) by the following BSA-based criteria:
- 0.25-0.29 m2 BSA: 220 mg IV over 60 minutes on day 1 of weeks 1 and 7
- 0.3-0.34 m2 BSA: 280 mg IV over 60 minutes on day 1 of weeks 1 and 7
- 0.35-0.39 m2 BSA: 360 mg IV over 60 minutes on day 1 of weeks 1 and 7
- 0.4-0.44 m2 BSA: 440 mg IV over 60 minutes on day 1 of weeks 1 and 7
- 0.45-0.49 m2 BSA: 520 mg IV over 60 minutes on day 1 of weeks 1 and 7
- 0.5-0.54 m2 BSA: 600 mg IV over 60 minutes on day 1 of weeks 1 and 7
- 0.55-0.59 m2 BSA: 660 mg IV over 60 minutes on day 1 of weeks 1 and 7
- ≥ 0.6 m2 BSA: 1200 mg/m2 IV over 60 minutes on day 1 of weeks 1 and 7
- Mesna (Mesnex) by the following BSA-based criteria:
Mesna (Mesnex) can also be given PO at twice the IV dose
- 0.25-0.29 m2 BSA: 176 mg IV over 15 to 30 minutes immediately before Cyclophosphamide (Cytoxan) infusion, and again 4 and 8 hours after the start of Cyclophosphamide (Cytoxan) infusion
- 0.3-0.34 m2 BSA: 224 mg IV over 15 to 30 minutes immediately before Cyclophosphamide (Cytoxan) infusion, and again 4 and 8 hours after the start of Cyclophosphamide (Cytoxan) infusion
- 0.35-0.39 m2 BSA: 288 mg IV over 15 to 30 minutes immediately before Cyclophosphamide (Cytoxan) infusion, and again 4 and 8 hours after the start of Cyclophosphamide (Cytoxan) infusion
- 0.4-0.44 m2 BSA: 352 mg IV over 15 to 30 minutes immediately before Cyclophosphamide (Cytoxan) infusion, and again 4 and 8 hours after the start of Cyclophosphamide (Cytoxan) infusion
- 0.45-0.49 m2 BSA: 416 mg IV over 15 to 30 minutes immediately before Cyclophosphamide (Cytoxan) infusion, and again 4 and 8 hours after the start of Cyclophosphamide (Cytoxan) infusion
- 0.5-0.54 m2 BSA: 480 mg IV over 15 to 30 minutes immediately before Cyclophosphamide (Cytoxan) infusion, and again 4 and 8 hours after the start of Cyclophosphamide (Cytoxan) infusion
- 0.55-0.59 m2 BSA: 528 mg IV over 15 to 30 minutes immediately before Cyclophosphamide (Cytoxan) infusion, and again 4 and 8 hours after the start of Cyclophosphamide (Cytoxan) infusion
- ≥ 0.6 m2 BSA: 960 mg/m2 IV over 15 to 30 minutes immediately before Cyclophosphamide (Cytoxan) infusion, and again 4 and 8 hours after the start of Cyclophosphamide (Cytoxan) infusion
- Irinotecan (Camptosar) by the following BSA-based criteria:
- 0.25-0.29 m2 BSA: 8 mg IV over 90 minutes once daily on days 1 through 5 of weeks 4 and 10
- 0.3-0.34 m2 BSA: 12 mg IV over 90 minutes once daily on days 1 through 5 of weeks 4 and 10
- 0.35-0.39 m2 BSA: 15 mg IV over 90 minutes once daily on days 1 through 5 of weeks 4 and 10
- 0.4-0.44 m2 BSA: 18 mg IV over 90 minutes once daily on days 1 through 5 of weeks 4 and 10
- 0.45-0.49 m2 BSA: 22 mg IV over 90 minutes once daily on days 1 through 5 of weeks 4 and 10
- 0.5-0.54 m2 BSA: 24 mg IV over 90 minutes once daily on days 1 through 5 of weeks 4 and 10
- 0.55-0.59 m2 BSA: 28 mg IV over 90 minutes once daily on days 1 through 5 of weeks 4 and 10
- ≥ 0.6 m2 BSA: 50 mg/m2 IV over 90 minutes once daily on days 1 through 5 of weeks 4 and 10
Cycles 5-10 (Weeks 13 through 30)
Chemotherapy
- Temsirolimus (Torisel) by the following weight-based criteria:
- < 10 kg: 0.5 mg/kg IV over 30 to 60 minutes once weekly on day 1 of weeks 21 through 30
- > 10 kg: 15 mg/m2 (maximum dose of 25 mg) IV on day 1 of weeks 21 through 30
- Vincristine (Oncovin) by the following BSA-based criteria:
- 0.25-0.29 m2 BSA: 0.24 mg IV push over 1 minute (or infusion via minibag as per institutional policy once weekly on day 1 of weeks 13, 16, 17, 19, 20, 22 through 26, 28
- 0.3-0.34 m2 BSA: 0.34 mg IV push over 1 minute (or infusion via minibag as per institutional policy once weekly on day 1 of weeks 13, 16, 17, 19, 20, 22 through 26, 28
- 0.35-0.39 m2 BSA: 0.44 mg IV push over 1 minute (or infusion via minibag as per institutional policy once weekly on day 1 of weeks 13, 16, 17, 19, 20, 22 through 26, 28
- 0.4-0.44 m2 BSA: 0.55 mg IV push over 1 minute (or infusion via minibag as per institutional policy once weekly on day 1 of weeks 13, 16, 17, 19, 20, 22 through 26, 28
- 0.45-0.49 m2 BSA: 0.65 mg IV push over 1 minute (or infusion via minibag as per institutional policy once weekly on day 1 of weeks 13, 16, 17, 19, 20, 22 through 26, 28
- 0.5-0.54 m2 BSA: 0.74 mg IV push over 1 minute (or infusion via minibag as per institutional policy once weekly on day 1 of weeks 13, 16, 17, 19, 20, 22 through 26, 28
- 0.55-0.59 m2 BSA: 0.8 mg IV push over 1 minute (or infusion via minibag as per institutional policy once weekly on day 1 of weeks 13, 16, 17, 19, 20, 22 through 26, 28
- ≥ 0.6 m2 BSA: 1.5 mg/m2 (maximum dose of 2 mg) IV push over 1 minute (or infusion via minibag as per institutional policy once weekly on day 1 of weeks 13, 16, 17, 19, 20, 22 through 26, 28
- Dactinomycin (Cosmegen) by the following weight-based criteria:
- 3-4.5 kg: 0.09 mg slow IV push over 1 to 5 minutes or IV infusion over 10 to 15 minutes on day 1 of weeks 13, 22, 28
- 4.6-6 kg: 0.14 mg slow IV push over 1 to 5 minutes or IV infusion over 10 to 15 minutes on day 1 of weeks 13, 22, 28
- 6.1-7.3 kg: 0.21 mg slow IV push over 1 to 5 minutes or IV infusion over 10 to 15 minutes on day 1 of weeks 13, 22, 28
- 7.4-8.6 kg: 0.26 mg slow IV push over 1 to 5 minutes or IV infusion over 10 to 15 minutes on day 1 of weeks 13, 22, 28
- 8.7-9.9 kg: 0.33 mg slow IV push over 1 to 5 minutes or IV infusion over 10 to 15 minutes on day 1 of weeks 13, 22, 28
- 10-11.2 kg: 0.4 mg slow IV push over 1 to 5 minutes or IV infusion over 10 to 15 minutes on day 1 of weeks 13, 22, 28
- 11.3-12.5 kg: 0.5 mg slow IV push over 1 to 5 minutes or IV infusion over 10 to 15 minutes on day 1 of weeks 13, 22, 28
- 12.6-13.9 kg: 0.6 mg slow IV push over 1 to 5 minutes or IV infusion over 10 to 15 minutes on day 1 of weeks 13, 22, 28
- ≥14 kg: 0.05 mg/kg (maximum dose of 2.5 mg) slow IV push over 1 to 5 minutes or IV infusion over 10 to 15 minutes on day 1 of weeks 13, 22, 28
Give week 13 dose of Dactinomycin (Cosmegen) before beginning radiation therapy
- Cyclophosphamide (Cytoxan) by the following BSA-based criteria:
- 0.25-0.29 m2 BSA: 220 mg IV over 60 minutes on day 1 of weeks 13, 22, 28
- 0.3-0.34 m2 BSA: 280 mg IV over 60 minutes on day 1 of weeks 13, 22, 28
- 0.35-0.39 m2 BSA: 360 mg IV over 60 minutes on day 1 of weeks 13, 22, 28
- 0.4-0.44 m2 BSA: 440 mg IV over 60 minutes on day 1 of weeks 13, 22, 28
- 0.45-0.49 m2 BSA: 520 mg IV over 60 minutes on day 1 of weeks 13, 22, 28
- 0.5-0.54 m2 BSA: 600 mg IV over 60 minutes on day 1 of weeks 13, 22, 28
- 0.55-0.59 m2 BSA: 660 mg IV over 60 minutes on day 1 of weeks 13, 22, 28
- ≥ 0.6 m2 BSA: 1200 mg/m2 IV over 60 minutes on day 1 of weeks 13, 22, 28
- Mesna (Mesnex) by the following BSA-based criteria:
Mesna (Mesnex) can also be given PO at twice the IV dose
- 0.25-0.29 m2 BSA: 176 mg IV over 15 to 30 minutes immediately before Cyclophosphamide (Cytoxan) infusion, and again 4 and 8 hours after the start of Cyclophosphamide (Cytoxan) infusion
- 0.3-0.34 m2 BSA: 224 mg IV over 15 to 30 minutes immediately before Cyclophosphamide (Cytoxan) infusion, and again 4 and 8 hours after the start of Cyclophosphamide (Cytoxan) infusion
- 0.35-0.39 m2 BSA: 288 mg IV over 15 to 30 minutes immediately before Cyclophosphamide (Cytoxan) infusion, and again 4 and 8 hours after the start of Cyclophosphamide (Cytoxan) infusion
- 0.4-0.44 m2 BSA: 352 mg IV over 15 to 30 minutes immediately before Cyclophosphamide (Cytoxan) infusion, and again 4 and 8 hours after the start of Cyclophosphamide (Cytoxan) infusion
- 0.45-0.49 m2 BSA: 416 mg IV over 15 to 30 minutes immediately before Cyclophosphamide (Cytoxan) infusion, and again 4 and 8 hours after the start of Cyclophosphamide (Cytoxan) infusion
- 0.5-0.54 m2 BSA: 480 mg IV over 15 to 30 minutes immediately before Cyclophosphamide (Cytoxan) infusion, and again 4 and 8 hours after the start of Cyclophosphamide (Cytoxan) infusion
- 0.55-0.59 m2 BSA: 528 mg IV over 15 to 30 minutes immediately before Cyclophosphamide (Cytoxan) infusion, and again 4 and 8 hours after the start of Cyclophosphamide (Cytoxan) infusion
- ≥ 0.6 m2 BSA: 960 mg/m2 IV over 15 to 30 minutes immediately before Cyclophosphamide (Cytoxan) infusion, and again 4 and 8 hours after the start of Cyclophosphamide (Cytoxan) infusion
- Irinotecan (Camptosar) by the following BSA-based criteria:
- 0.25-0.29 m2 BSA: 8 mg IV over 90 minutes once daily on days 1 through 5 of weeks 16, 19, 25
- 0.3-0.34 m2 BSA: 12 mg IV over 90 minutes once daily on days 1 through 5 of weeks 16, 19, 25
- 0.35-0.39 m2 BSA: 15 mg IV over 90 minutes once daily on days 1 through 5 of weeks 16, 19, 25
- 0.4-0.44 m2 BSA: 18 mg IV over 90 minutes once daily on days 1 through 5 of weeks 16, 19, 25
- 0.45-0.49 m2 BSA: 22 mg IV over 90 minutes once daily on days 1 through 5 of weeks 16, 19, 25
- 0.5-0.54 m2 BSA: 24 mg IV over 90 minutes once daily on days 1 through 5 of weeks 16, 19, 25
- 0.55-0.59 m2 BSA: 28 mg IV over 90 minutes once daily on days 1 through 5 of weeks 16, 19, 25
- ≥ 0.6 m2 BSA: 50 mg/m2 IV over 90 minutes once daily on days 1 through 5 of weeks 16, 19, 25
Cycles 11-14 (Weeks 31 through 42)
Chemotherapy
- Temsirolimus (Torisel) by the following weight-based criteria:
- < 10 kg: 0.5 mg/kg IV over 30 to 60 minutes once weekly on day 1 of weeks 31 through 42
- > 10 kg: 15 mg/m2 (maximum dose of 25 mg) IV on day 1 of weeks 31 through 42
- Vincristine (Oncovin) by the following BSA-based criteria:
- 0.25-0.29 m2 BSA: 0.24 mg IV push over 1 minute (or infusion via minibag as per institutional policy once weekly on day 1 of weeks 31 through 34, 37, 38, 40
- 0.3-0.34 m2 BSA: 0.34 mg IV push over 1 minute (or infusion via minibag as per institutional policy once weekly on day 1 of weeks 31 through 34, 37, 38, 40
- 0.35-0.39 m2 BSA: 0.44 mg IV push over 1 minute (or infusion via minibag as per institutional policy once weekly on day 1 of weeks 31 through 34, 37, 38, 40
- 0.4-0.44 m2 BSA: 0.55 mg IV push over 1 minute (or infusion via minibag as per institutional policy once weekly on day 1 of weeks 31 through 34, 37, 38, 40
- 0.45-0.49 m2 BSA: 0.65 mg IV push over 1 minute (or infusion via minibag as per institutional policy once weekly on day 1 of weeks 31 through 34, 37, 38, 40
- 0.5-0.54 m2 BSA: 0.74 mg IV push over 1 minute (or infusion via minibag as per institutional policy once weekly on day 1 of weeks 31 through 34, 37, 38, 40
- 0.55-0.59 m2 BSA: 0.8 mg IV push over 1 minute (or infusion via minibag as per institutional policy once weekly on day 1 of weeks 31 through 34, 37, 38, 40
- ≥ 0.6 m2 BSA: 1.5 mg/m2 (maximum dose of 2 mg) IV push over 1 minute (or infusion via minibag as per institutional policy once weekly on day 1 of weeks 31 through 34, 37, 38, 40
- Dactinomycin (Cosmegen) by the following weight-based criteria:
- 3-4.5 kg: 0.09 mg slow IV push over 1 to 5 minutes or IV infusion over 10 to 15 minutes on day 1 of weeks 34, 40
- 4.6-6 kg: 0.14 mg slow IV push over 1 to 5 minutes or IV infusion over 10 to 15 minutes on day 1 of weeks 34, 40
- 6.1-7.3 kg: 0.21 mg slow IV push over 1 to 5 minutes or IV infusion over 10 to 15 minutes on day 1 of weeks 34, 40
- 7.4-8.6 kg: 0.26 mg slow IV push over 1 to 5 minutes or IV infusion over 10 to 15 minutes on day 1 of weeks 34, 40
- 8.7-9.9 kg: 0.33 mg slow IV push over 1 to 5 minutes or IV infusion over 10 to 15 minutes on day 1 of weeks 34, 40
- 10-11.2 kg: 0.4 mg slow IV push over 1 to 5 minutes or IV infusion over 10 to 15 minutes on day 1 of weeks 34, 40
- 11.3-12.5 kg: 0.5 mg slow IV push over 1 to 5 minutes or IV infusion over 10 to 15 minutes on day 1 of weeks 34, 40
- 12.6-13.9 kg: 0.6 mg slow IV push over 1 to 5 minutes or IV infusion over 10 to 15 minutes on day 1 of weeks 34, 40
- ≥14 kg: 0.05 mg/kg (maximum dose of 2.5 mg) slow IV push over 1 to 5 minutes or IV infusion over 10 to 15 minutes on day 1 of weeks 34, 40
- Cyclophosphamide (Cytoxan) by the following BSA-based criteria:
- 0.25-0.29 m2 BSA: 220 mg IV over 60 minutes on day 1 of weeks 34, 40
- 0.3-0.34 m2 BSA: 280 mg IV over 60 minutes on day 1 of weeks 34, 40
- 0.35-0.39 m2 BSA: 360 mg IV over 60 minutes on day 1 of weeks 34, 40
- 0.4-0.44 m2 BSA: 440 mg IV over 60 minutes on day 1 of weeks 34, 40
- 0.45-0.49 m2 BSA: 520 mg IV over 60 minutes on day 1 of weeks 34, 40
- 0.5-0.54 m2 BSA: 600 mg IV over 60 minutes on day 1 of weeks 34, 40
- 0.55-0.59 m2 BSA: 660 mg IV over 60 minutes on day 1 of weeks 34, 40
- ≥ 0.6 m2 BSA: 1200 mg/m2 IV over 60 minutes on day 1 of weeks 34, 40
- Mesna (Mesnex) by the following BSA-based criteria:
Mesna (Mesnex) can also be given PO at twice the IV dose
- 0.25-0.29 m2 BSA: 176 mg IV over 15 to 30 minutes immediately before Cyclophosphamide (Cytoxan) infusion, and again 4 and 8 hours after the start of Cyclophosphamide (Cytoxan) infusion
- 0.3-0.34 m2 BSA: 224 mg IV over 15 to 30 minutes immediately before Cyclophosphamide (Cytoxan) infusion, and again 4 and 8 hours after the start of Cyclophosphamide (Cytoxan) infusion
- 0.35-0.39 m2 BSA: 288 mg IV over 15 to 30 minutes immediately before Cyclophosphamide (Cytoxan) infusion, and again 4 and 8 hours after the start of Cyclophosphamide (Cytoxan) infusion
- 0.4-0.44 m2 BSA: 352 mg IV over 15 to 30 minutes immediately before Cyclophosphamide (Cytoxan) infusion, and again 4 and 8 hours after the start of Cyclophosphamide (Cytoxan) infusion
- 0.45-0.49 m2 BSA: 416 mg IV over 15 to 30 minutes immediately before Cyclophosphamide (Cytoxan) infusion, and again 4 and 8 hours after the start of Cyclophosphamide (Cytoxan) infusion
- 0.5-0.54 m2 BSA: 480 mg IV over 15 to 30 minutes immediately before Cyclophosphamide (Cytoxan) infusion, and again 4 and 8 hours after the start of Cyclophosphamide (Cytoxan) infusion
- 0.55-0.59 m2 BSA: 528 mg IV over 15 to 30 minutes immediately before Cyclophosphamide (Cytoxan) infusion, and again 4 and 8 hours after the start of Cyclophosphamide (Cytoxan) infusion
- ≥ 0.6 m2 BSA: 960 mg/m2 IV over 15 to 30 minutes immediately before Cyclophosphamide (Cytoxan) infusion, and again 4 and 8 hours after the start of Cyclophosphamide (Cytoxan) infusion
- Irinotecan (Camptosar) by the following BSA-based criteria:
- 0.25-0.29 m2 BSA: 8 mg IV over 90 minutes once daily on days 1 through 5 of weeks 31, 37
- 0.3-0.34 m2 BSA: 12 mg IV over 90 minutes once daily on days 1 through 5 of weeks 31, 37
- 0.35-0.39 m2 BSA: 15 mg IV over 90 minutes once daily on days 1 through 5 of weeks 31, 37
- 0.4-0.44 m2 BSA: 18 mg IV over 90 minutes once daily on days 1 through 5 of weeks 31, 37
- 0.45-0.49 m2 BSA: 22 mg IV over 90 minutes once daily on days 1 through 5 of weeks 31, 37
- 0.5-0.54 m2 BSA: 24 mg IV over 90 minutes once daily on days 1 through 5 of weeks 31, 37
- 0.55-0.59 m2 BSA: 28 mg IV over 90 minutes once daily on days 1 through 5 of weeks 31, 37
- ≥ 0.6 m2 BSA: 50 mg/m2 IV over 90 minutes once daily on days 1 through 5 of weeks 31, 37
Maintenance Cycles 1-6
Chemotherapy
- Vinorelbine (Navelbine) by the following BSA-based criteria:
- 0.25-0.29 m2 BSA: 4 mg IV push over 6 to 10 minutes on days 1, 8, and 15
- 0.3-0.34 m2 BSA: 6 mg IV push over 6 to 10 minutes on days 1, 8, and 15
- 0.35-0.39 m2 BSA: 7.5 mg IV push over 6 to 10 minutes on days 1, 8, and 15
- 0.4-0.44 m2 BSA: 9 mg IV push over 6 to 10 minutes on days 1, 8, and 15
- 0.45-0.49 m2 BSA: 11 mg IV push over 6 to 10 minutes on days 1, 8, and 15
- 0.5-0.54 m2 BSA: 12 mg IV push over 6 to 10 minutes on days 1, 8, and 15
- 0.55-0.59 m2 BSA: 14 mg IV push over 6 to 10 minutes on days 1, 8, and 15
- ≥ 0.6 m2 BSA: 25 mg/m2 IV push over 6 to 10 minutes on days 1, 8, and 15
- Cyclophosphamide (Cytoxan) 25 mg/m2 PO once daily on days 1 through 28
- Dose rounded to the nearest 25 mg capsule
28 day cycle
References
- COG ARST1431: Maintenance therapy: Bisogno G, De Salvo GL, Bergeron C, Gallego Melcons s, Merks JH, Kelsey A, Martelli H, Minard-Colin V, Orbach D, Glosli H, Chisholm J, Casanova M, Zanetti I, Devalck C, Ben-Arush M, Mudry P, Ferman S, Jenney M, Ferrari A. Vinorelbine and continuous low-dose cyclophosphamide as maintenance chemotherapy in patients with high-risk rhabdomyosarcoma (RMS 2005): a multicentre, open-label, randomised, phase 3 tial. Lancet Oncol. 2019 Nov;20(11):1566-1575. link to original article PubMed NCT02567435
Low Risk
COG ARST1431
Regimen C (VAC/VA Only)
Cycles 1-4 (Weeks 1 through 12)
Chemotherapy
- Vincristine (Oncovin) by the following BSA-based criteria:
- 0.25-0.29 m2 BSA: 0.24 mg IV push over 1 minute (or infusion via minibag as per institutional policy once weekly on day 1 of weeks 1 through 10
- 0.3-0.34 m2 BSA: 0.34 mg IV push over 1 minute (or infusion via minibag as per institutional policy once weekly on day 1 of weeks 1 through 10
- 0.35-0.39 m2 BSA: 0.44 mg IV push over 1 minute (or infusion via minibag as per institutional policy once weekly on day 1 of weeks 1 through 10
- 0.4-0.44 m2 BSA: 0.55 mg IV push over 1 minute (or infusion via minibag as per institutional policy once weekly on day 1 of weeks 1 through 10
- 0.45-0.49 m2 BSA: 0.65 mg IV push over 1 minute (or infusion via minibag as per institutional policy once weekly on day 1 of weeks 1 through 10
- 0.5-0.54 m2 BSA: 0.74 mg IV push over 1 minute (or infusion via minibag as per institutional policy once weekly on day 1 of weeks 1 through 10
- 0.55-0.59 m2 BSA: 0.8 mg IV push over 1 minute (or infusion via minibag as per institutional policy once weekly on day 1 of weeks 1 through 10
- ≥ 0.6 m2 BSA: 1.5 mg/m2 (maximum dose of 2 mg) IV push over 1 minute (or infusion via minibag as per institutional policy once weekly on day 1 of weeks 1 through 10
- Dactinomycin (Cosmegen) by the following weight-based criteria:
- 3-4.5 kg: 0.09 mg slow IV push over 1 to 5 minutes or IV infusion over 10 to 15 minutes on day 1 of weeks 1, 4, 7, 10
- 4.6-6 kg: 0.14 mg slow IV push over 1 to 5 minutes or IV infusion over 10 to 15 minutes on day 1 of weeks 1, 4, 7, 10
- 6.1-7.3 kg: 0.21 mg slow IV push over 1 to 5 minutes or IV infusion over 10 to 15 minutes on day 1 of weeks 1, 4, 7, 10
- 7.4-8.6 kg: 0.26 mg slow IV push over 1 to 5 minutes or IV infusion over 10 to 15 minutes on day 1 of weeks 1, 4, 7, 10
- 8.7-9.9 kg: 0.33 mg slow IV push over 1 to 5 minutes or IV infusion over 10 to 15 minutes on day 1 of weeks 1, 4, 7, 10
- 10-11.2 kg: 0.4 mg slow IV push over 1 to 5 minutes or IV infusion over 10 to 15 minutes on day 1 of weeks 1, 4, 7, 10
- 11.3-12.5 kg: 0.5 mg slow IV push over 1 to 5 minutes or IV infusion over 10 to 15 minutes on day 1 of weeks 1, 4, 7, 10
- 12.6-13.9 kg: 0.6 mg slow IV push over 1 to 5 minutes or IV infusion over 10 to 15 minutes on day 1 of weeks 1, 4, 7, 10
- ≥14 kg: 0.05 mg/kg (maximum dose of 2.5 mg) slow IV push over 1 to 5 minutes or IV infusion over 10 to 15 minutes on day 1 of weeks 1, 4, 7, 10
- Cyclophosphamide (Cytoxan) by the following BSA-based criteria:
- 0.25-0.29 m2 BSA: 220 mg IV over 60 minutes on day 1 of weeks 1, 4, 7, 10
- 0.3-0.34 m2 BSA: 280 mg IV over 60 minutes on day 1 of weeks 1, 4, 7, 10
- 0.35-0.39 m2 BSA: 360 mg IV over 60 minutes on day 1 of weeks 1, 4, 7, 10
- 0.4-0.44 m2 BSA: 440 mg IV over 60 minutes on day 1 of weeks 1, 4, 7, 10
- 0.45-0.49 m2 BSA: 520 mg IV over 60 minutes on day 1 of weeks 1, 4, 7, 10
- 0.5-0.54 m2 BSA: 600 mg IV over 60 minutes on day 1 of weeks 1, 4, 7, 10
- 0.55-0.59 m2 BSA: 660 mg IV over 60 minutes on day 1 of weeks 1, 4, 7, 10
- ≥ 0.6 m2 BSA: 1200 mg/m2 IV over 60 minutes on day 1 of weeks 1, 4, 7, 10
- Mesna (Mesnex) by the following BSA-based criteria:
Mesna (Mesnex) can also be given PO at twice the IV dose
- 0.25-0.29 m2 BSA: 176 mg IV over 15 to 30 minutes immediately before Cyclophosphamide (Cytoxan) infusion, and again 4 and 8 hours after the start of Cyclophosphamide (Cytoxan) infusion
- 0.3-0.34 m2 BSA: 224 mg IV over 15 to 30 minutes immediately before Cyclophosphamide (Cytoxan) infusion, and again 4 and 8 hours after the start of Cyclophosphamide (Cytoxan) infusion
- 0.35-0.39 m2 BSA: 288 mg IV over 15 to 30 minutes immediately before Cyclophosphamide (Cytoxan) infusion, and again 4 and 8 hours after the start of Cyclophosphamide (Cytoxan) infusion
- 0.4-0.44 m2 BSA: 352 mg IV over 15 to 30 minutes immediately before Cyclophosphamide (Cytoxan) infusion, and again 4 and 8 hours after the start of Cyclophosphamide (Cytoxan) infusion
- 0.45-0.49 m2 BSA: 416 mg IV over 15 to 30 minutes immediately before Cyclophosphamide (Cytoxan) infusion, and again 4 and 8 hours after the start of Cyclophosphamide (Cytoxan) infusion
- 0.5-0.54 m2 BSA: 480 mg IV over 15 to 30 minutes immediately before Cyclophosphamide (Cytoxan) infusion, and again 4 and 8 hours after the start of Cyclophosphamide (Cytoxan) infusion
- 0.55-0.59 m2 BSA: 528 mg IV over 15 to 30 minutes immediately before Cyclophosphamide (Cytoxan) infusion, and again 4 and 8 hours after the start of Cyclophosphamide (Cytoxan) infusion
- ≥ 0.6 m2 BSA: 960 mg/m2 IV over 15 to 30 minutes immediately before Cyclophosphamide (Cytoxan) infusion, and again 4 and 8 hours after the start of Cyclophosphamide (Cytoxan) infusion
Cycles 5-8 (Weeks 13 through 24)
Chemotherapy
- Vincristine (Oncovin) by the following BSA-based criteria:
- 0.25-0.29 m2 BSA: 0.24 mg IV push over 1 minute (or infusion via minibag as per institutional policy once weekly on day 1 of weeks 13 through 22
- 0.3-0.34 m2 BSA: 0.34 mg IV push over 1 minute (or infusion via minibag as per institutional policy once weekly on day 1 of weeks 13 through 22
- 0.35-0.39 m2 BSA: 0.44 mg IV push over 1 minute (or infusion via minibag as per institutional policy once weekly on day 1 of weeks 13 through 22
- 0.4-0.44 m2 BSA: 0.55 mg IV push over 1 minute (or infusion via minibag as per institutional policy once weekly on day 1 of weeks 13 through 22
- 0.45-0.49 m2 BSA: 0.65 mg IV push over 1 minute (or infusion via minibag as per institutional policy once weekly on day 1 of weeks 13 through 22
- 0.5-0.54 m2 BSA: 0.74 mg IV push over 1 minute (or infusion via minibag as per institutional policy once weekly on day 1 of weeks 13 through 22
- 0.55-0.59 m2 BSA: 0.8 mg IV push over 1 minute (or infusion via minibag as per institutional policy once weekly on day 1 of weeks 13 through 22
- ≥ 0.6 m2 BSA: 1.5 mg/m2 (maximum dose of 2 mg) IV push over 1 minute (or infusion via minibag as per institutional policy once weekly on day 1 of weeks 13 through 22
- Dactinomycin (Cosmegen) by the following weight-based criteria:
- 3-4.5 kg: 0.09 mg slow IV push over 1 to 5 minutes or IV infusion over 10 to 15 minutes on day 1 of weeks 13, 16, 19, 22
- 4.6-6 kg: 0.14 mg slow IV push over 1 to 5 minutes or IV infusion over 10 to 15 minutes on day 1 of weeks 13, 16, 19, 22
- 6.1-7.3 kg: 0.21 mg slow IV push over 1 to 5 minutes or IV infusion over 10 to 15 minutes on day 1 of weeks 13, 16, 19, 22
- 7.4-8.6 kg: 0.26 mg slow IV push over 1 to 5 minutes or IV infusion over 10 to 15 minutes on day 1 of weeks 13, 16, 19, 22
- 8.7-9.9 kg: 0.33 mg slow IV push over 1 to 5 minutes or IV infusion over 10 to 15 minutes on day 1 of weeks 13, 16, 19, 22
- 10-11.2 kg: 0.4 mg slow IV push over 1 to 5 minutes or IV infusion over 10 to 15 minutes on day 1 of weeks 13, 16, 19, 22
- 11.3-12.5 kg: 0.5 mg slow IV push over 1 to 5 minutes or IV infusion over 10 to 15 minutes on day 1 of weeks 13, 16, 19, 22
- 12.6-13.9 kg: 0.6 mg slow IV push over 1 to 5 minutes or IV infusion over 10 to 15 minutes on day 1 of weeks 13, 16, 19, 22
- ≥14 kg: 0.05 mg/kg (maximum dose of 2.5 mg) slow IV push over 1 to 5 minutes or IV infusion over 10 to 15 minutes on day 1 of weeks 13, 16, 19, 22
References
- COG ARST1431: Maintenance therapy: Bisogno G, De Salvo GL, Bergeron C, Gallego Melcons s, Merks JH, Kelsey A, Martelli H, Minard-Colin V, Orbach D, Glosli H, Chisholm J, Casanova M, Zanetti I, Devalck C, Ben-Arush M, Mudry P, Ferman S, Jenney M, Ferrari A. Vinorelbine and continuous low-dose cyclophosphamide as maintenance chemotherapy in patients with high-risk rhabdomyosarcoma (RMS 2005): a multicentre, open-label, randomised, phase 3 tial. Lancet Oncol. 2019 Nov;20(11):1566-1575. link to original article PubMed NCT02567435
High Risk
COG ARST0431
IRIN-VCR (Weeks 1-6)
Week 1 (IRIN-VCR)
- Vincristine (Oncovin) by the following age-based criteria:
- Age ≥ 3 years: 1.5 mg/m2 (maximum dose of 2 mg) IV push over 1 minute once on day 1
- Age ≥ 1 year to < 3 years: 0.05 mg/kg (maximum dose of 2 mg) IV push over 1 minute once on day 1
- Age < 1 year: 0.025 mg/kg IV push over 1 minute once on day 1
Administer Vincristine (Oncovin) before Irinotecan (Camptosar)
- Irinotecan (Camptosar) 50 mg/m2 (maximum dose of 100 mg/day) IV over 60 minutes once per day on days 1 through 5
Week 2 (VCR)
- Vincristine (Oncovin) by the following age-based criteria:
- Age ≥ 3 years: 1.5 mg/m2 (maximum dose of 2 mg) IV push over 1 minute once on day 1
- Age ≥ 1 year to < 3 years: 0.05 mg/kg (maximum dose of 2 mg) IV push over 1 minute once on day 1
- Age < 1 year: 0.025 mg/kg IV push over 1 minute once on day 1
Week 3 (VCR)
- Vincristine (Oncovin) by the following age-based criteria:
- Age ≥ 3 years: 1.5 mg/m2 (maximum dose of 2 mg) IV push over 1 minute once on day 1
- Age ≥ 1 year to < 3 years: 0.05 mg/kg (maximum dose of 2 mg) IV push over 1 minute once on day 1
- Age < 1 year: 0.025 mg/kg IV push over 1 minute once on day 1
Week 4 (IRIN-VCR)
- Vincristine (Oncovin) by the following age-based criteria:
- Age ≥ 3 years: 1.5 mg/m2 (maximum dose of 2 mg) IV push over 1 minute once on day 1
- Age ≥ 1 year to < 3 years: 0.05 mg/kg (maximum dose of 2 mg) IV push over 1 minute once on day 1
- Age < 1 year: 0.025 mg/kg IV push over 1 minute once on day 1
Administer Vincristine (Oncovin) before Irinotecan (Camptosar)
- Irinotecan (Camptosar) 50 mg/m2 (maximum dose of 100 mg/day) IV over 60 minutes once per day on days 1 through 5
Week 5 (VCR)
- Vincristine (Oncovin) by the following age-based criteria:
- Age ≥ 3 years: 1.5 mg/m2 (maximum dose of 2 mg) IV push over 1 minute once on day 1
- Age ≥ 1 year to < 3 years: 0.05 mg/kg (maximum dose of 2 mg) IV push over 1 minute once on day 1
- Age < 1 year: 0.025 mg/kg IV push over 1 minute once on day 1
Week 6
- Evaluation Week
VDC/IE (Weeks 7-19)
Week 7 (VDC)
- Vincristine (Oncovin) by the following age-based criteria:
- Age ≥ 3 years: 1.5 mg/m2 (maximum dose of 2 mg) IV push over 1 minute once on day 1
- Age ≥ 1 year to < 3 years: 0.05 mg/kg (maximum dose of 2 mg) IV push over 1 minute once on day 1
- Age < 1 year: 0.025 mg/kg IV push over 1 minute once on day 1
- Doxorubicin (Adriamycin) by the following age-based criteria:
- Age ≥ 1 year: 37.5 mg/m2 (Total dose per week of 75 mg/m2) IV over 24 hours once per day on days 1 through 2
- Age < 1 year: 18.75 mg/m2 IV over 24 hours once per day on days 1 through 2
- Cyclophosphamide (Cytoxan) by the following age-based criteria:
- Age ≥ 3 years: 1200 mg/m2 IV over 1 hour once per day on day 1
- Age < 3 years: 40mg/kg IV over 1 hour once per day on day 1
- Mesna (Mesnex) by the following age-based criteria:
- Age ≥ 3 years: 240 mg/m2 at hour 0, 4, and 8 from the start of each Cyclophosphamide (Cytoxan) infusion on days 1
- Age < 3 years: 8 mg/kg at hour 0, 4, and 8 from the start of each Cyclophosphamide (Cytoxan) infusion on days 1
Week 8 (VCR)
- Vincristine (Oncovin) by the following age-based criteria:
- Age ≥ 3 years: 1.5 mg/m2 (maximum dose of 2 mg) IV push over 1 minute once on day 1
- Age ≥ 1 year to < 3 years: 0.05 mg/kg (maximum dose of 2 mg) IV push over 1 minute once on day 1
- Age < 1 year: 0.025 mg/kg IV push over 1 minute once on day 1
Week 9 (IE)
- Ifosfamide (Ifex) by the following age-based criteria:
- Age ≥ 1 year: 1800 mg/m2 IV over 1 hour once per day on days 1 through 5
- Age < 1 year: 900 mg/m2 IV over 1 hour once per day on days 1 through 5
- Mesna (Mesnex) by the following age-based criteria:
- Age ≥ 3 years: 360 mg/m2 at hour 0, 4, and 8 from the start of each Ifosfamide (Ifex) infusion on days 1 through 5
- Age < 3 years: 180 mg/m2 at hour 0, 4, and 8 from the start of each Ifosfamide (Ifex) infusion on days 1 through 5
- Etoposide (Vepesid) by the following age-based criteria:
- Age ≥ 1 year: 100 mg/m2 IV over 30 to 60 minutes once per day on days 1 through 5
- Age < 1 year: 50 mg/m2 IV over 30 to 60 minutes once per day on days 1 through 5
Week 10
- Off Chemotherapy Week
Week 11 (VDC)
- Vincristine (Oncovin) by the following age-based criteria:
- Age ≥ 3 years: 1.5 mg/m2 (maximum dose of 2 mg) IV push over 1 minute once on day 1
- Age ≥ 1 year to < 3 years: 0.05 mg/kg (maximum dose of 2 mg) IV push over 1 minute once on day 1
- Age < 1 year: 0.025 mg/kg IV push over 1 minute once on day 1
- Doxorubicin (Adriamycin) by the following age-based criteria:
- Age ≥ 1 year: 37.5 mg/m2 (Total dose per week of 75 mg/m2) IV over 24 hours once per day on days 1 through 2
- Age < 1 year: 18.75 mg/m2 IV over 24 hours once per day on days 1 through 2
- Cyclophosphamide (Cytoxan) by the following age-based criteria:
- Age ≥ 3 years: 1200 mg/m2 IV over 1 hour once per day on day 1
- Age < 3 years: 40mg/kg IV over 1 hour once per day on day 1
- Mesna (Mesnex) by the following age-based criteria:
- Age ≥ 3 years: 240 mg/m2 at hour 0, 4, and 8 from the start of each Cyclophosphamide (Cytoxan) infusion on days 1
- Age < 3 years: 8 mg/kg at hour 0, 4, and 8 from the start of each Cyclophosphamide (Cytoxan) infusion on days 1
Week 12 (VCR)
- Vincristine (Oncovin) by the following age-based criteria:
- Age ≥ 3 years: 1.5 mg/m2 (maximum dose of 2 mg) IV push over 1 minute once on day 1
- Age ≥ 1 year to < 3 years: 0.05 mg/kg (maximum dose of 2 mg) IV push over 1 minute once on day 1
- Age < 1 year: 0.025 mg/kg IV push over 1 minute once on day 1
Week 13 (IE)
- Ifosfamide (Ifex) by the following age-based criteria:
- Age ≥ 1 year: 1800 mg/m2 IV over 1 hour once per day on days 1 through 5
- Age < 1 year: 900 mg/m2 IV over 1 hour once per day on days 1 through 5
- Mesna (Mesnex) by the following age-based criteria:
- Age ≥ 3 years: 360 mg/m2 at hour 0, 4, and 8 from the start of each Ifosfamide (Ifex) infusion on days 1 through 5
- Age < 3 years: 180 mg/m2 at hour 0, 4, and 8 from the start of each Ifosfamide (Ifex) infusion on days 1 through 5
- Etoposide (Vepesid) by the following age-based criteria:
- Age ≥ 1 year: 100 mg/m2 IV over 30 to 60 minutes once per day on days 1 through 5
- Age < 1 year: 50 mg/m2 IV over 30 to 60 minutes once per day on days 1 through 5
Week 14
- Off Chemotherapy Week
Week 15 (VDC)
- Vincristine (Oncovin) by the following age-based criteria:
- Age ≥ 3 years: 1.5 mg/m2 (maximum dose of 2 mg) IV push over 1 minute once on day 1
- Age ≥ 1 year to < 3 years: 0.05 mg/kg (maximum dose of 2 mg) IV push over 1 minute once on day 1
- Age < 1 year: 0.025 mg/kg IV push over 1 minute once on day 1
- Doxorubicin (Adriamycin) by the following age-based criteria:
- Age ≥ 1 year: 37.5 mg/m2 (Total dose per week of 75 mg/m2) IV over 24 hours once per day on days 1 through 2
- Age < 1 year: 18.75 mg/m2 IV over 24 hours once per day on days 1 through 2
- Cyclophosphamide (Cytoxan) by the following age-based criteria:
- Age ≥ 3 years: 1200 mg/m2 IV over 1 hour once per day on day 1
- Age < 3 years: 40mg/kg IV over 1 hour once per day on day 1
- Mesna (Mesnex) by the following age-based criteria:
- Age ≥ 3 years: 240 mg/m2 at hour 0, 4, and 8 from the start of each Cyclophosphamide (Cytoxan) infusion on days 1
- Age < 3 years: 8 mg/kg at hour 0, 4, and 8 from the start of each Cyclophosphamide (Cytoxan) infusion on days 1
Week 16 (VCR)
- Vincristine (Oncovin) by the following age-based criteria:
- Age ≥ 3 years: 1.5 mg/m2 (maximum dose of 2 mg) IV push over 1 minute once on day 1
- Age ≥ 1 year to < 3 years: 0.05 mg/kg (maximum dose of 2 mg) IV push over 1 minute once on day 1
- Age < 1 year: 0.025 mg/kg IV push over 1 minute once on day 1
Week 17 (IE)
- Ifosfamide (Ifex) by the following age-based criteria:
- Age ≥ 1 year: 1800 mg/m2 IV over 1 hour once per day on days 1 through 5
- Age < 1 year: 900 mg/m2 IV over 1 hour once per day on days 1 through 5
- Mesna (Mesnex) by the following age-based criteria:
- Age ≥ 3 years: 360 mg/m2 at hour 0, 4, and 8 from the start of each Ifosfamide (Ifex) infusion on days 1 through 5
- Age < 3 years: 180 mg/m2 at hour 0, 4, and 8 from the start of each Ifosfamide (Ifex) infusion on days 1 through 5
- Etoposide (Vepesid) by the following age-based criteria:
- Age ≥ 1 year: 100 mg/m2 IV over 30 to 60 minutes once per day on days 1 through 5
- Age < 1 year: 50 mg/m2 IV over 30 to 60 minutes once per day on days 1 through 5
Week 18
- Off Chemotherapy Week
Week 19
- Evaluation Week
IRIN-VCR/IE/VDC (Weeks 20-34)
Week 20 (IRIN-VCR)
- Vincristine (Oncovin) by the following age-based criteria:
- Age ≥ 3 years: 1.5 mg/m2 (maximum dose of 2 mg) IV push over 1 minute once on day 1
- Age ≥ 1 year to < 3 years: 0.05 mg/kg (maximum dose of 2 mg) IV push over 1 minute once on day 1
- Age < 1 year: 0.025 mg/kg IV push over 1 minute once on day 1
Administer Vincristine (Oncovin) before Irinotecan (Camptosar)
- Irinotecan (Camptosar) 50 mg/m2 (maximum dose of 100 mg/day) IV over 60 minutes once per day on days 1 through 5
Week 21 (VCR)
- Vincristine (Oncovin) by the following age-based criteria:
- Age ≥ 3 years: 1.5 mg/m2 (maximum dose of 2 mg) IV push over 1 minute once on day 1
- Age ≥ 1 year to < 3 years: 0.05 mg/kg (maximum dose of 2 mg) IV push over 1 minute once on day 1
- Age < 1 year: 0.025 mg/kg IV push over 1 minute once on day 1
Week 22 (VCR)
- Vincristine (Oncovin) by the following age-based criteria:
- Age ≥ 3 years: 1.5 mg/m2 (maximum dose of 2 mg) IV push over 1 minute once on day 1
- Age ≥ 1 year to < 3 years: 0.05 mg/kg (maximum dose of 2 mg) IV push over 1 minute once on day 1
- Age < 1 year: 0.025 mg/kg IV push over 1 minute once on day 1
Week 23 (IRIN-VCR)
- Vincristine (Oncovin) by the following age-based criteria:
- Age ≥ 3 years: 1.5 mg/m2 (maximum dose of 2 mg) IV push over 1 minute once on day 1
- Age ≥ 1 year to < 3 years: 0.05 mg/kg (maximum dose of 2 mg) IV push over 1 minute once on day 1
- Age < 1 year: 0.025 mg/kg IV push over 1 minute once on day 1
Administer Vincristine (Oncovin) before Irinotecan (Camptosar)
- Irinotecan (Camptosar) 50 mg/m2 (maximum dose of 100 mg/day) IV over 60 minutes once per day on days 1 through 5
Week 24 (VCR)
- Vincristine (Oncovin) by the following age-based criteria:
- Age ≥ 3 years: 1.5 mg/m2 (maximum dose of 2 mg) IV push over 1 minute once on day 1
- Age ≥ 1 year to < 3 years: 0.05 mg/kg (maximum dose of 2 mg) IV push over 1 minute once on day 1
- Age < 1 year: 0.025 mg/kg IV push over 1 minute once on day 1
Week 25
- Off Chemotherapy Week
Week 26 (IE)
- Ifosfamide (Ifex) by the following age-based criteria:
- Age ≥ 1 year: 1800 mg/m2 IV over 1 hour once per day on days 1 through 5
- Age < 1 year: 900 mg/m2 IV over 1 hour once per day on days 1 through 5
- Mesna (Mesnex) by the following age-based criteria:
- Age ≥ 3 years: 360 mg/m2 at hour 0, 4, and 8 from the start of each Ifosfamide (Ifex) infusion on days 1 through 5
- Age < 3 years: 180 mg/m2 at hour 0, 4, and 8 from the start of each Ifosfamide (Ifex) infusion on days 1 through 5
- Etoposide (Vepesid) by the following age-based criteria:
- Age ≥ 1 year: 100 mg/m2 IV over 30 to 60 minutes once per day on days 1 through 5
- Age < 1 year: 50 mg/m2 IV over 30 to 60 minutes once per day on days 1 through 5
Week 27
- Off Chemotherapy Week
Week 28 (VDC)
- Vincristine (Oncovin) by the following age-based criteria:
- Age ≥ 3 years: 1.5 mg/m2 (maximum dose of 2 mg) IV push over 1 minute once on day 1
- Age ≥ 1 year to < 3 years: 0.05 mg/kg (maximum dose of 2 mg) IV push over 1 minute once on day 1
- Age < 1 year: 0.025 mg/kg IV push over 1 minute once on day 1
- Doxorubicin (Adriamycin) by the following age-based criteria:
- Age ≥ 1 year: 37.5 mg/m2 (Total dose per week of 75 mg/m2) IV over 24 hours once per day on days 1 through 2
- Age < 1 year: 18.75 mg/m2 IV over 24 hours once per day on days 1 through 2
- Cyclophosphamide (Cytoxan) by the following age-based criteria:
- Age ≥ 3 years: 1200 mg/m2 IV over 1 hour once per day on day 1
- Age < 3 years: 40mg/kg IV over 1 hour once per day on day 1
- Mesna (Mesnex) by the following age-based criteria:
- Age ≥ 3 years: 240 mg/m2 at hour 0, 4, and 8 from the start of each Cyclophosphamide (Cytoxan) infusion on days 1
- Age < 3 years: 8 mg/kg at hour 0, 4, and 8 from the start of each Cyclophosphamide (Cytoxan) infusion on days 1
Week 29 (VCR)
- Vincristine (Oncovin) by the following age-based criteria:
- Age ≥ 3 years: 1.5 mg/m2 (maximum dose of 2 mg) IV push over 1 minute once on day 1
- Age ≥ 1 year to < 3 years: 0.05 mg/kg (maximum dose of 2 mg) IV push over 1 minute once on day 1
- Age < 1 year: 0.025 mg/kg IV push over 1 minute once on day 1
Week 30 (IE)
- Ifosfamide (Ifex) by the following age-based criteria:
- Age ≥ 1 year: 1800 mg/m2 IV over 1 hour once per day on days 1 through 5
- Age < 1 year: 900 mg/m2 IV over 1 hour once per day on days 1 through 5
- Mesna (Mesnex) by the following age-based criteria:
- Age ≥ 3 years: 360 mg/m2 at hour 0, 4, and 8 from the start of each Ifosfamide (Ifex) infusion on days 1 through 5
- Age < 3 years: 180 mg/m2 at hour 0, 4, and 8 from the start of each Ifosfamide (Ifex) infusion on days 1 through 5
- Etoposide (Vepesid) by the following age-based criteria:
- Age ≥ 1 year: 100 mg/m2 IV over 30 to 60 minutes once per day on days 1 through 5
- Age < 1 year: 50 mg/m2 IV over 30 to 60 minutes once per day on days 1 through 5
Week 31
- Off Chemotherapy Week
Week 32 (VDC)
- Vincristine (Oncovin) by the following age-based criteria:
- Age ≥ 3 years: 1.5 mg/m2 (maximum dose of 2 mg) IV push over 1 minute once on day 1
- Age ≥ 1 year to < 3 years: 0.05 mg/kg (maximum dose of 2 mg) IV push over 1 minute once on day 1
- Age < 1 year: 0.025 mg/kg IV push over 1 minute once on day 1
- Doxorubicin (Adriamycin) by the following age-based criteria:
- Age ≥ 1 year: 37.5 mg/m2 (Total dose per week of 75 mg/m2) IV over 24 hours once per day on days 1 through 2
- Age < 1 year: 18.75 mg/m2 IV over 24 hours once per day on days 1 through 2
- Cyclophosphamide (Cytoxan) by the following age-based criteria:
- Age ≥ 3 years: 1200 mg/m2 IV over 1 hour once per day on day 1
- Age < 3 years: 40mg/kg IV over 1 hour once per day on day 1
- Mesna (Mesnex) by the following age-based criteria:
- Age ≥ 3 years: 240 mg/m2 at hour 0, 4, and 8 from the start of each Cyclophosphamide (Cytoxan) infusion on days 1
- Age < 3 years: 8 mg/kg at hour 0, 4, and 8 from the start of each Cyclophosphamide (Cytoxan) infusion on days 1
Week 33 (VCR)
- Vincristine (Oncovin) by the following age-based criteria:
- Age ≥ 3 years: 1.5 mg/m2 (maximum dose of 2 mg) IV push over 1 minute once on day 1
- Age ≥ 1 year to < 3 years: 0.05 mg/kg (maximum dose of 2 mg) IV push over 1 minute once on day 1
- Age < 1 year: 0.025 mg/kg IV push over 1 minute once on day 1
Week 34
- Evaluation Week
VAC/IRIN-VCR (Weeks 35-54)
Week 35 (VAC)
- Vincristine (Oncovin) by the following age-based criteria:
- Age ≥ 3 years: 1.5 mg/m2 (maximum dose of 2 mg) IV push over 1 minute once on day 1
- Age ≥ 1 year to < 3 years: 0.05 mg/kg (maximum dose of 2 mg) IV push over 1 minute once on day 1
- Age < 1 year: 0.025 mg/kg IV push over 1 minute once on day 1
- Dactinomycin (Cosmegen) by the following age-based criteria:
- Age ≥ 1 year: 0.045 mg/kg (maximum dose of 2.5 mg) IV push over 1 to 5 minutes once per day on day 1
- Age < 1 year: 0.025 mg/kg IV over 1 to 5 minutes once per day on day 1
- Cyclophosphamide (Cytoxan) by the following age-based criteria:
- Age ≥ 3 years: 1200 mg/m2 IV over 1 hour once per day on day 1
- Age < 3 years: 40mg/kg IV over 1 hour once per day on day 1
- Mesna (Mesnex) by the following age-based criteria:
- Age ≥ 3 years: 240 mg/m2 at hour 0, 4, and 8 from the start of each Cyclophosphamide (Cytoxan) infusion on days 1
- Age < 3 years: 8 mg/kg at hour 0, 4, and 8 from the start of each Cyclophosphamide (Cytoxan) infusion on days 1
Week 36
- Off Chemotherapy Week
Week 37
- Off Chemotherapy Week
Week 38 (VAC)
- Vincristine (Oncovin) by the following age-based criteria:
- Age ≥ 3 years: 1.5 mg/m2 (maximum dose of 2 mg) IV push over 1 minute once on day 1
- Age ≥ 1 year to < 3 years: 0.05 mg/kg (maximum dose of 2 mg) IV push over 1 minute once on day 1
- Age < 1 year: 0.025 mg/kg IV push over 1 minute once on day 1
- Dactinomycin (Cosmegen) by the following age-based criteria:
- Age ≥ 1 year: 0.045 mg/kg (maximum dose of 2.5 mg) IV push over 1 to 5 minutes once per day on day 1
- Age < 1 year: 0.025 mg/kg IV over 1 to 5 minutes once per day on day 1
- Cyclophosphamide (Cytoxan) by the following age-based criteria:
- Age ≥ 3 years: 1200 mg/m2 IV over 1 hour once per day on day 1
- Age < 3 years: 40mg/kg IV over 1 hour once per day on day 1
- Mesna (Mesnex) by the following age-based criteria:
- Age ≥ 3 years: 240 mg/m2 at hour 0, 4, and 8 from the start of each Cyclophosphamide (Cytoxan) infusion on days 1
- Age < 3 years: 8 mg/kg at hour 0, 4, and 8 from the start of each Cyclophosphamide (Cytoxan) infusion on days 1
Week 39
- Off Chemotherapy Week
Week 40
- Off Chemotherapy Week
Week 41 (VAC)
- Vincristine (Oncovin) by the following age-based criteria:
- Age ≥ 3 years: 1.5 mg/m2 (maximum dose of 2 mg) IV push over 1 minute once on day 1
- Age ≥ 1 year to < 3 years: 0.05 mg/kg (maximum dose of 2 mg) IV push over 1 minute once on day 1
- Age < 1 year: 0.025 mg/kg IV push over 1 minute once on day 1
- Dactinomycin (Cosmegen) by the following age-based criteria:
- Age ≥ 1 year: 0.045 mg/kg (maximum dose of 2.5 mg) IV push over 1 to 5 minutes once per day on day 1
- Age < 1 year: 0.025 mg/kg IV over 1 to 5 minutes once per day on day 1
- Cyclophosphamide (Cytoxan) by the following age-based criteria:
- Age ≥ 3 years: 1200 mg/m2 IV over 1 hour once per day on day 1
- Age < 3 years: 40mg/kg IV over 1 hour once per day on day 1
- Mesna (Mesnex) by the following age-based criteria:
- Age ≥ 3 years: 240 mg/m2 at hour 0, 4, and 8 from the start of each Cyclophosphamide (Cytoxan) infusion on days 1
- Age < 3 years: 8 mg/kg at hour 0, 4, and 8 from the start of each Cyclophosphamide (Cytoxan) infusion on days 1
Week 42 (VCR)
- Vincristine (Oncovin) by the following age-based criteria:
- Age ≥ 3 years: 1.5 mg/m2 (maximum dose of 2 mg) IV push over 1 minute once on day 1
- Age ≥ 1 year to < 3 years: 0.05 mg/kg (maximum dose of 2 mg) IV push over 1 minute once on day 1
- Age < 1 year: 0.025 mg/kg IV push over 1 minute once on day 1
Week 43 (VCR)
- Vincristine (Oncovin) by the following age-based criteria:
- Age ≥ 3 years: 1.5 mg/m2 (maximum dose of 2 mg) IV push over 1 minute once on day 1
- Age ≥ 1 year to < 3 years: 0.05 mg/kg (maximum dose of 2 mg) IV push over 1 minute once on day 1
- Age < 1 year: 0.025 mg/kg IV push over 1 minute once on day 1
Week 44 (VAC)
- Vincristine (Oncovin) by the following age-based criteria:
- Age ≥ 3 years: 1.5 mg/m2 (maximum dose of 2 mg) IV push over 1 minute once on day 1
- Age ≥ 1 year to < 3 years: 0.05 mg/kg (maximum dose of 2 mg) IV push over 1 minute once on day 1
- Age < 1 year: 0.025 mg/kg IV push over 1 minute once on day 1
- Dactinomycin (Cosmegen) by the following age-based criteria:
- Age ≥ 1 year: 0.045 mg/kg (maximum dose of 2.5 mg) IV push over 1 to 5 minutes once per day on day 1
- Age < 1 year: 0.025 mg/kg IV over 1 to 5 minutes once per day on day 1
- Cyclophosphamide (Cytoxan) by the following age-based criteria:
- Age ≥ 3 years: 1200 mg/m2 IV over 1 hour once per day on day 1
- Age < 3 years: 40mg/kg IV over 1 hour once per day on day 1
- Mesna (Mesnex) by the following age-based criteria:
- Age ≥ 3 years: 240 mg/m2 at hour 0, 4, and 8 from the start of each Cyclophosphamide (Cytoxan) infusion on days 1
- Age < 3 years: 8 mg/kg at hour 0, 4, and 8 from the start of each Cyclophosphamide (Cytoxan) infusion on days 1
Week 45
- Off Chemotherapy Week
Week 46
- Off Chemotherapy Week
Week 47 (IRIN-VCR)
- Vincristine (Oncovin) by the following age-based criteria:
- Age ≥ 3 years: 1.5 mg/m2 (maximum dose of 2 mg) IV push over 1 minute once on day 1
- Age ≥ 1 year to < 3 years: 0.05 mg/kg (maximum dose of 2 mg) IV push over 1 minute once on day 1
- Age < 1 year: 0.025 mg/kg IV push over 1 minute once on day 1
Administer Vincristine (Oncovin) before Irinotecan (Camptosar)
- Irinotecan (Camptosar) 50 mg/m2 (maximum dose of 100 mg/day) IV over 60 minutes once per day on days 1 through 5
Week 48 (VCR)
- Vincristine (Oncovin) by the following age-based criteria:
- Age ≥ 3 years: 1.5 mg/m2 (maximum dose of 2 mg) IV push over 1 minute once on day 1
- Age ≥ 1 year to < 3 years: 0.05 mg/kg (maximum dose of 2 mg) IV push over 1 minute once on day 1
- Age < 1 year: 0.025 mg/kg IV push over 1 minute once on day 1
Week 49
- Off Chemotherapy Week
Week 50 (IRIN-VCR)
- Vincristine (Oncovin) by the following age-based criteria:
- Age ≥ 3 years: 1.5 mg/m2 (maximum dose of 2 mg) IV push over 1 minute once on day 1
- Age ≥ 1 year to < 3 years: 0.05 mg/kg (maximum dose of 2 mg) IV push over 1 minute once on day 1
- Age < 1 year: 0.025 mg/kg IV push over 1 minute once on day 1
Administer Vincristine (Oncovin) before Irinotecan (Camptosar)
- Irinotecan (Camptosar) 50 mg/m2 (maximum dose of 100 mg/day) IV over 60 minutes once per day on days 1 through 5
Week 51 (VCR)
- Vincristine (Oncovin) by the following age-based criteria:
- Age ≥ 3 years: 1.5 mg/m2 (maximum dose of 2 mg) IV push over 1 minute once on day 1
- Age ≥ 1 year to < 3 years: 0.05 mg/kg (maximum dose of 2 mg) IV push over 1 minute once on day 1
- Age < 1 year: 0.025 mg/kg IV push over 1 minute once on day 1
Week 52
- Off Chemotherapy Week
Week 53
- Off Chemotherapy Week
Week 54
- Evaluation Week
References
- COG ARST0431: Weigel BJ, Lyden E, Anderson JR, Meyer WH, Parham DM, Rodeberg DA, Michalski JM, Hawkins DS, Arndt CAS. Intensive Multiagent Therapy, Including Dose-Compressed Cycles of Ifosfamide/Etoposide and Vincristine/Doxorubicin/Cyclophosphamide, Irinotecan, and Radiation, in Patients with High-Risk Rhabdomyosarcoma: A Report from the Children's Oncology Group. Journal of Clinical Oncology. 2016 Oct;34(2):117-122. link to original article link to PMC article PubMed NCT00354744