Neuroblastoma - historical
The purpose of this page is to provide references to regimens that are obsolete, outdated, or of historical interest only.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
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High Risk
COG ANBL0532 Regimen A
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 μg/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 μg/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,
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 μg/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, 6 Cycles
Chemotherapy,
- Isotretinoin (Accutane) by the following weight-based criteria:
- ≤ 12 kg: 5.33 mg/kg (Round dose to nearest 10 mg) PO twice daily on days 1 through 14
- > 12 kg: 160 mg/m2 (Round dose to nearest 10 mg) PO twice daily on days 1 through 14
28 Day Cycle
References
- COG ANBL0532:Seif AE, Naranjo A, Baker DL, Bunin NJ, Kletzel M, Kretschmar CS, Maris JM, McGrady PW, von Allmen D, Cohn SL, London WB, Park JR, Diller LR, Grupp SA. A pilot study of tandem high-dose chemotherapy with stem cell rescue as consolidation for high-risk neuroblastoma: Children's Oncology Group study ANBL00P1. Bone Marrow Transplant. 2013 Jul;48(7):947-52. link to original article link to PMC article PubMed
COG ANBL 0032 Regimen A
Post Consolidation, Study Phase
6 Courses
Chemotherapy
- Isotretinoin (Accutane) by the following weight based criteria:
- > 12 kg: 80 mg/m2 (Round to nearest 10 mg) PO BID on days 11 through 24
- ≤ 12 kg: 2.67 mg/kg (Round to nearest 10 mg) PO BID on days 11 through 24
25-Day Course
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 R, Gillies SD, Cohn SL, Maris JM, Sondel PM. Anti-GD2 Antibody with GM-CSF, IL2, and Isotretinoin for Neuroblastoma. N Engl J Med. 2010 Sep;363(14):1324-34. link to original article link to PMC article PubMed