Ewing sarcoma, pediatric

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Upfront Therapy

COGAEWS0031 Protocol

Regimen A Induction

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
  • NOTE: Protocol states that Mesna (Mesnex) should be dosed as AT LEAST 60% of Cyclophosphamide (Cytoxan) m²
  • Mesna (Mesnex) continuous infusion should be started at the same time as the Cyclophosphamide (Cytoxan) and remain until at least 8 hours after the end of the Cyclophosphamide (Cytoxan) infusion
• 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
  • NOTE: Protocol states that Mesna (Mesnex) should be dosed as AT LEAST 60% of Ifosfamide (Ifex) m²
  • Mesna (Mesnex) continuous infusion should be started at the same time as the Ifosfamide (Ifex) and remain until at least 8 hours after the end of the Ifosfamide (Ifex) infusion
• 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

Cycle 5 & 9 (VDC)

Cycle 5 begins on week 15 in patients receiving surgery week 13 (Regimen A1/A3)

• 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
  • NOTE: Protocol states that Mesna (Mesnex) should be dosed as AT LEAST 60% of Cyclophosphamide (Cytoxan) m²
  • Mesna (Mesnex) continuous infusion should be started at the same time as the Cyclophosphamide (Cytoxan) and remain until at least 8 hours after the end of the Cyclophosphamide (Cytoxan) infusion
• 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
  • NOTE: Protocol states that Mesna (Mesnex) should be dosed as AT LEAST 60% of Ifosfamide (Ifex) m²
  • Mesna (Mesnex) continuous infusion should be started at the same time as the Ifosfamide (Ifex) and remain until at least 8 hours after the end of the Ifosfamide (Ifex) infusion
• 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

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