Ewing sarcoma, pediatric - historical

From HemOnc.org - A Hematology Oncology Wiki
Jump to navigation Jump to search

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The purpose of this page is to provide references to regimens that are obsolete, outdated, or of historical interest only.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 Ewing Sarcoma, pediatric page for current regimens.

0 regimens on this page
0 variants on this page


Historical Regimens

COG AEWS0031

Regimen A Induction

  • Regimen A is a standard regimen consisting of 21 day cycles

Cycles 1 & 3 (VDC)

  • Vincristine (Oncovin) 2 mg/m2 IV push once on day 1 (maximum dose of 2 mg)
    • Treat with 50% doses calculated on a m2 basis for children < 1 year, then consider increasing to 75% and then to 100 % of calculated dose if tolerated
  • Doxorubicin (Adriamycin) 75 mg/m2 IV infusion over 48 hours once on day 1
    • Treat with 50% doses calculated on a m2 basis for children < 1 year, then consider increasing to 75% and then to 100 % of calculated dose if tolerated
  • Cyclophosphamide (Cytoxan) 1200 mg/m2 IV over 1 hour on Days 1
    • Treat with 50% doses calculated on a m2 basis for children < 1 year, then consider increasing to 75% and then to 100 % of calculated dose if tolerated
  • Mesna (Mesnex) 720 mg/m2 IV continuous infusion on day 1
  • Filgrastim (Neupogen) 5 mcg/kg SC for at least 7 days, or until ANC ≥ 750/μl, beginning on day 2
    • ANC ≥ 750/μl on or before day 7 of the cycle is not sufficient for discontinuing G-CSF

21 day cycle

Cycles 2 & 4 (IE)

  • Ifosfamide (Ifex) 1800 mg/m2 IV infusion over 1 hour once on day 1 to 5
    • Treat with 50% doses calculated on a m2 basis for children < 1 year, then consider increasing to 75% and then to 100 % of calculated dose if tolerated
  • Etoposide (Vepesid) 100 mg/m2 IV infusion over 1 to 2 hours once on days 1 to 5
    • Treat with 50% doses calculated on a m2 basis for children < 1 year, then consider increasing to 75% and then to 100 % of calculated dose if tolerated
  • Mesna (Mesnex) 1080 mg/m2 IV continuous infusion on day 1
  • Filgrastim (Neupogen) 5 mcg/kg SC for at least 7 days, or until ANC ≥ 750/μl, beginning on day 6
    • ANC ≥ 750/μl on or before day 7 of the cycle is not sufficient for discontinuing G-CSF

21 day cycle

Regimen A Continuation

  • At week 13 patients either underwent surgery, received radiation, or both
  • Radiation coincided with cycle 5

Cycle 5 & 9 (VDC)

Cycle 5 begins on week 15 in patients receiving surgery and on week 13 in Regimen A2
  • Vincristine (Oncovin) 2 mg/m2 IV push once on day 1 (maximum dose of 2 mg)
    • Treat with 50% doses calculated on a m2 basis for children < 1 year, then consider increasing to 75% and then to 100 % of calculated dose if tolerated
  • Doxorubicin (Adriamycin) 75 mg/m2 IV infusion over 48 hours once on day 1
    • Treat with 50% doses calculated on a m2 basis for children < 1 year, then consider increasing to 75% and then to 100 % of calculated dose if tolerated
  • Cyclophosphamide (Cytoxan) 1200 mg/m2 IV over 1 hour on Days 1
    • Treat with 50% doses calculated on a m2 basis for children < 1 year, then consider increasing to 75% and then to 100 % of calculated dose if tolerated
  • Mesna (Mesnex) 720 mg/m2 IV continuous infusion on day 1
  • Filgrastim (Neupogen) 5 mcg/kg SC for at least 7 days, or until ANC ≥ 750/μl, beginning on day 2
    • ANC ≥ 750/μl on or before day 7 of the cycle is not sufficient for discontinuing G-CSF

21 day cycle

Cycle 6, 8, 10, 12, & 14 (IE)

  • Ifosfamide (Ifex) 1800 mg/m2 IV infusion over 1 hour once on day 1 to 5
    • Treat with 50% doses calculated on a m2 basis for children < 1 year, then consider increasing to 75% and then to 100 % of calculated dose if tolerated
  • Etoposide (Vepesid) 100 mg/m2 IV infusion over 1 to 2 hours once on days 1 to 5
    • Treat with 50% doses calculated on a m2 basis for children < 1 year, then consider increasing to 75% and then to 100 % of calculated dose if tolerated
  • Mesna (Mesnex) 1080 mg/m2 IV continuous infusion on day 1
  • Filgrastim (Neupogen) 5 mcg/kg SC for at least 7 days, or until ANC ≥ 750/μl, beginning on day 6
    • ANC ≥ 750/μl on or before day 7 of the cycle is not sufficient for discontinuing G-CSF

21 day cycle

Cycle 7 (VDC) Regimen A1 (Surgery Only)

  • Vincristine (Oncovin) 2 mg/m2 IV push once on day 1 (maximum dose of 2 mg)
    • Treat with 50% doses calculated on a m2 basis for children < 1 year, then consider increasing to 75% and then to 100 % of calculated dose if tolerated
  • Doxorubicin (Adriamycin) 75 mg/m2 IV infusion over 48 hours once on day 1
    • Treat with 50% doses calculated on a m2 basis for children < 1 year, then consider increasing to 75% and then to 100 % of calculated dose if tolerated
  • Cyclophosphamide (Cytoxan) 1200 mg/m2 IV over 1 hour on Days 1
    • Treat with 50% doses calculated on a m2 basis for children < 1 year, then consider increasing to 75% and then to 100 % of calculated dose if tolerated
  • Mesna (Mesnex) 720 mg/m2 IV continuous infusion on day 1
  • Filgrastim (Neupogen) 5 mcg/kg SC for at least 7 days, or until ANC ≥ 750/μl, beginning on day 2
    • ANC ≥ 750/μl on or before day 7 of the cycle is not sufficient for discontinuing G-CSF

21 day cycle

Cycle 7 (VC) Regimen A2 & A3 (Radiation w/ or w/o Surgery)

  • Vincristine (Oncovin) 2 mg/m2 IV push once on day 1 (maximum dose of 2 mg)
    • Treat with 50% doses calculated on a m2 basis for children < 1 year, then consider increasing to 75% and then to 100 % of calculated dose if tolerated
  • Cyclophosphamide (Cytoxan) 1200 mg/m2 IV over 1 hour on Days 1
    • Treat with 50% doses calculated on a m2 basis for children < 1 year, then consider increasing to 75% and then to 100 % of calculated dose if tolerated
  • Mesna (Mesnex) 720 mg/m2 IV continuous infusion on day 1
  • Filgrastim (Neupogen) 5 mcg/kg SC for at least 7 days, or until ANC ≥ 750/μl, beginning on day 2
    • ANC ≥ 750/μl on or before day 7 of the cycle is not sufficient for discontinuing G-CSF

21 day cycle

Cycle 11 (VC) Regimen A1 (Surgery Only)

  • Vincristine (Oncovin) 2 mg/m2 IV push once on day 1 (maximum dose of 2 mg)
    • Treat with 50% doses calculated on a m2 basis for children < 1 year, then consider increasing to 75% and then to 100 % of calculated dose if tolerated
  • Cyclophosphamide (Cytoxan) 1200 mg/m2 IV over 1 hour on Days 1
    • Treat with 50% doses calculated on a m2 basis for children < 1 year, then consider increasing to 75% and then to 100 % of calculated dose if tolerated
  • Mesna (Mesnex) 720 mg/m2 IV continuous infusion on day 1
  • Filgrastim (Neupogen) 5 mcg/kg SC for at least 7 days, or until ANC ≥ 750/μl, beginning on day 2
    • ANC ≥ 750/μl on or before day 7 of the cycle is not sufficient for discontinuing G-CSF

21 day cycle

Cycle 11 (VDC) Regimen A2 & A3 (Radiation w/ or w/o Surgery)

  • Vincristine (Oncovin) 2 mg/m2 IV push once on day 1 (maximum dose of 2 mg)
    • Treat with 50% doses calculated on a m2 basis for children < 1 year, then consider increasing to 75% and then to 100 % of calculated dose if tolerated
  • Doxorubicin (Adriamycin) 75 mg/m2 IV infusion over 48 hours once on day 1
    • Treat with 50% doses calculated on a m2 basis for children < 1 year, then consider increasing to 75% and then to 100 % of calculated dose if tolerated
  • Cyclophosphamide (Cytoxan) 1200 mg/m2 IV over 1 hour on Days 1
    • Treat with 50% doses calculated on a m2 basis for children < 1 year, then consider increasing to 75% and then to 100 % of calculated dose if tolerated
  • Mesna (Mesnex) 720 mg/m2 IV continuous infusion on day 1
  • Filgrastim (Neupogen) 5 mcg/kg SC for at least 7 days, or until ANC ≥ 750/μl, beginning on day 2
    • ANC ≥ 750/μl on or before day 7 of the cycle is not sufficient for discontinuing G-CSF

21 day cycle

Cycle 13 (VC)

  • Vincristine (Oncovin) 2 mg/m2 IV push once on day 1 (maximum dose of 2 mg)
    • Treat with 50% doses calculated on a m2 basis for children < 1 year, then consider increasing to 75% and then to 100 % of calculated dose if tolerated
  • Cyclophosphamide (Cytoxan) 1200 mg/m2 IV over 1 hour on Days 1
    • Treat with 50% doses calculated on a m2 basis for children < 1 year, then consider increasing to 75% and then to 100 % of calculated dose if tolerated
  • Mesna (Mesnex) 720 mg/m2 IV continuous infusion on day 1
  • Filgrastim (Neupogen) 5 mcg/kg SC for at least 7 days, or until ANC ≥ 750/μl, beginning on day 2
    • ANC ≥ 750/μl on or before day 7 of the cycle is not sufficient for discontinuing G-CSF

21 day cycle

Regimen B Induction

  • Regimen B is a consolidated regimen consisting of 14 day cycles

Cycles 1, 3, & 5 (VDC)

  • Vincristine (Oncovin) 2 mg/m2 IV push once on day 1 (maximum dose of 2 mg)
    • Treat with 50% doses calculated on a m2 basis for children < 1 year, then consider increasing to 75% and then to 100 % of calculated dose if tolerated
  • Doxorubicin (Adriamycin) 75 mg/m2 IV infusion over 48 hours once on day 1
    • Treat with 50% doses calculated on a m2 basis for children < 1 year, then consider increasing to 75% and then to 100 % of calculated dose if tolerated
  • Cyclophosphamide (Cytoxan) 1200 mg/m2 IV over 1 hour on Days 1
    • Treat with 50% doses calculated on a m2 basis for children < 1 year, then consider increasing to 75% and then to 100 % of calculated dose if tolerated
  • Mesna (Mesnex) 720 mg/m2 IV continuous infusion on day 1
  • Filgrastim (Neupogen) 5 mcg/kg SC for at least 7 days, or until ANC ≥ 750/μl, beginning on day 2
    • ANC ≥ 750/μl on or before day 7 of the cycle is not sufficient for discontinuing G-CSF

14 day cycle

Cycle 2, 4, & 6 (IE)

  • Ifosfamide (Ifex) 1800 mg/m2 IV infusion over 1 hour once on day 1 to 5
    • Treat with 50% doses calculated on a m2 basis for children < 1 year, then consider increasing to 75% and then to 100 % of calculated dose if tolerated
  • Etoposide (Vepesid) 100 mg/m2 IV infusion over 1 to 2 hours once on days 1 to 5
    • Treat with 50% doses calculated on a m2 basis for children < 1 year, then consider increasing to 75% and then to 100 % of calculated dose if tolerated
  • Mesna (Mesnex) 1080 mg/m2 IV continuous infusion on day 1
  • Filgrastim (Neupogen) 5 mcg/kg SC for at least 7 days, or until ANC ≥ 750/μl, beginning on day 6
    • ANC ≥ 750/μl on or before day 7 of the cycle is not sufficient for discontinuing G-CSF

14 day cycle

Regimen B Continuation

  • At week 13 patients either underwent surgery, received radiation, or both
  • Radiation coincided with cycle 7

Cycle 7 (VDC)

Cycle 7 begins on week 15 in patients receiving surgery and on week 13 in Regimen B2
  • Vincristine (Oncovin) 2 mg/m2 IV push once on day 1 (maximum dose of 2 mg)
    • Treat with 50% doses calculated on a m2 basis for children < 1 year, then consider increasing to 75% and then to 100 % of calculated dose if tolerated
  • Doxorubicin (Adriamycin) 75 mg/m2 IV infusion over 48 hours once on day 1
    • Treat with 50% doses calculated on a m2 basis for children < 1 year, then consider increasing to 75% and then to 100 % of calculated dose if tolerated
  • Cyclophosphamide (Cytoxan) 1200 mg/m2 IV over 1 hour on Days 1
    • Treat with 50% doses calculated on a m2 basis for children < 1 year, then consider increasing to 75% and then to 100 % of calculated dose if tolerated
  • Mesna (Mesnex) 720 mg/m2 IV continuous infusion on day 1
  • Filgrastim (Neupogen) 5 mcg/kg SC for at least 7 days, or until ANC ≥ 750/μl, beginning on day 2
    • ANC ≥ 750/μl on or before day 7 of the cycle is not sufficient for discontinuing G-CSF

14 day cycle


Cycle 8, 10, 12, & 14 (IE)

  • Ifosfamide (Ifex) 1800 mg/m2 IV infusion over 1 hour once on day 1 to 5
    • Treat with 50% doses calculated on a m2 basis for children < 1 year, then consider increasing to 75% and then to 100 % of calculated dose if tolerated
  • Etoposide (Vepesid) 100 mg/m2 IV infusion over 1 to 2 hours once on days 1 to 5
    • Treat with 50% doses calculated on a m2 basis for children < 1 year, then consider increasing to 75% and then to 100 % of calculated dose if tolerated
  • Mesna (Mesnex) 1080 mg/m2 IV continuous infusion on day 1
  • Filgrastim (Neupogen) 5 mcg/kg SC for at least 7 days, or until ANC ≥ 750/μl, beginning on day 6
    • ANC ≥ 750/μl on or before day 7 of the cycle is not sufficient for discontinuing G-CSF

14 day cycle

Cycle 9 (VDC) Regimen B1 (Surgery Only)

  • Vincristine (Oncovin) 2 mg/m2 IV push once on day 1 (maximum dose of 2 mg)
    • Treat with 50% doses calculated on a m2 basis for children < 1 year, then consider increasing to 75% and then to 100 % of calculated dose if tolerated
  • Doxorubicin (Adriamycin) 75 mg/m2 IV infusion over 48 hours once on day 1
    • Treat with 50% doses calculated on a m2 basis for children < 1 year, then consider increasing to 75% and then to 100 % of calculated dose if tolerated
  • Cyclophosphamide (Cytoxan) 1200 mg/m2 IV over 1 hour on Days 1
    • Treat with 50% doses calculated on a m2 basis for children < 1 year, then consider increasing to 75% and then to 100 % of calculated dose if tolerated
  • Mesna (Mesnex) 720 mg/m2 IV continuous infusion on day 1
  • Filgrastim (Neupogen) 5 mcg/kg SC for at least 7 days, or until ANC ≥ 750/μl, beginning on day 2
    • ANC ≥ 750/μl on or before day 7 of the cycle is not sufficient for discontinuing G-CSF

14 day cycle

Cycle 9 (VC) Regimen B2 & B3 (Radiation w/ or w/o Surgery)

  • Vincristine (Oncovin) 2 mg/m2 IV push once on day 1 (maximum dose of 2 mg)
    • Treat with 50% doses calculated on a m2 basis for children < 1 year, then consider increasing to 75% and then to 100 % of calculated dose if tolerated
  • Cyclophosphamide (Cytoxan) 1200 mg/m2 IV over 1 hour on Days 1
    • Treat with 50% doses calculated on a m2 basis for children < 1 year, then consider increasing to 75% and then to 100 % of calculated dose if tolerated
  • Mesna (Mesnex) 720 mg/m2 IV continuous infusion on day 1
  • Filgrastim (Neupogen) 5 mcg/kg SC for at least 7 days, or until ANC ≥ 750/μl, beginning on day 2
    • ANC ≥ 750/μl on or before day 7 of the cycle is not sufficient for discontinuing G-CSF

14 day cycle

Cycle 11 (VC)

  • Vincristine (Oncovin) 2 mg/m2 IV push once on day 1 (maximum dose of 2 mg)
    • Treat with 50% doses calculated on a m2 basis for children < 1 year, then consider increasing to 75% and then to 100 % of calculated dose if tolerated
  • Cyclophosphamide (Cytoxan) 1200 mg/m2 IV over 1 hour on Days 1
    • Treat with 50% doses calculated on a m2 basis for children < 1 year, then consider increasing to 75% and then to 100 % of calculated dose if tolerated
  • Mesna (Mesnex) 720 mg/m2 IV continuous infusion on day 1
  • Filgrastim (Neupogen) 5 mcg/kg SC for at least 7 days, or until ANC ≥ 750/μl, beginning on day 2
    • ANC ≥ 750/μl on or before day 7 of the cycle is not sufficient for discontinuing G-CSF

14 day cycle

Cycle 13 (VC) Regimen B1 (Surgery Only)

  • Vincristine (Oncovin) 2 mg/m2 IV push once on day 1 (maximum dose of 2 mg)
    • Treat with 50% doses calculated on a m2 basis for children < 1 year, then consider increasing to 75% and then to 100 % of calculated dose if tolerated
  • Cyclophosphamide (Cytoxan) 1200 mg/m2 IV over 1 hour on Days 1
    • Treat with 50% doses calculated on a m2 basis for children < 1 year, then consider increasing to 75% and then to 100 % of calculated dose if tolerated
  • Mesna (Mesnex) 720 mg/m2 IV continuous infusion on day 1
  • Filgrastim (Neupogen) 5 mcg/kg SC for at least 7 days, or until ANC ≥ 750/μl, beginning on day 2
    • ANC ≥ 750/μl on or before day 7 of the cycle is not sufficient for discontinuing G-CSF

14 day cycle

Cycle 13 (VDC) Regimen B2 & B3 (Radiation w/ or w/o Surgery)

  • Vincristine (Oncovin) 2 mg/m2 IV push once on day 1 (maximum dose of 2 mg)
    • Treat with 50% doses calculated on a m2 basis for children < 1 year, then consider increasing to 75% and then to 100 % of calculated dose if tolerated
  • Doxorubicin (Adriamycin) 75 mg/m2 IV infusion over 48 hours once on day 1
    • Treat with 50% doses calculated on a m2 basis for children < 1 year, then consider increasing to 75% and then to 100 % of calculated dose if tolerated
  • Cyclophosphamide (Cytoxan) 1200 mg/m2 IV over 1 hour on Days 1
    • Treat with 50% doses calculated on a m2 basis for children < 1 year, then consider increasing to 75% and then to 100 % of calculated dose if tolerated
  • Mesna (Mesnex) 720 mg/m2 IV continuous infusion on day 1
  • Filgrastim (Neupogen) 5 mcg/kg SC for at least 7 days, or until ANC ≥ 750/μl, beginning on day 2
    • ANC ≥ 750/μl on or before day 7 of the cycle is not sufficient for discontinuing G-CSF

14 day cycle

References

  1. COG AEWS0031: Womer RB, West DC, Krailo MD, Dickman PS, Pawel BR, Grier HE, Marcus K, Sailer S, Healey JH, Dormans JP, and Weiss AR. Randomized Controlled Trial of Interval-Compressed Chemotherapy for the Treatment of Localized Ewing Sarcoma: A Report From the Children's Oncology Group. J Clin Oncol. 2012 Nov 20;30(33):4148-4154. link to original article link to PMC article PubMed NCT00006734