Rhabdomyosarcoma, pediatric

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

Section editor transclusions

0 regimens on this page
0 variants on this page


Intermediate Risk

COG ARST1431 (In Process)

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) can also be given PO at twice the IV dose
  • 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) can also be given PO at twice the IV dose
  • 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) can also be given PO at twice the IV dose
  • 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

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) can also be given PO at twice the IV dose
  • 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) can also be given PO at twice the IV dose
  • 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) can also be given PO at twice the IV dose
  • 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

28 day cycle

Low Risk

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) can also be given PO at twice the IV dose

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
  1. 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

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:

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:

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:

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:

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:

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:

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:

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:

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:

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

  1. 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
Retrieved from "https://hemonc.org/w/index.php?title=Rhabdomyosarcoma,_pediatric&oldid=57245"