Ewing sarcoma, pediatric
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Upfront Therapy
COG AEWS1031
Regimen A Induction
- Regimen A is a standard regimen consisting of 14 day cycles
Cycles 1, 3, & 5 (VDC)
- Vincristine (Oncovin) 1.5 mg/m2/dose IV push once on day 1 of weeks 1, 2, 5, 6, 9 & 10 (maximum dose of 2 mg)
- For children < 10 kg or < 1 year, the dose is 0.05 mg/kg/dose
- Doxorubicin (Adriamycin) 37.5 mg/m2/dose IV push/infusion over 1-15 minutes on days 1 and 2 of weeks 1, 5 and 9.
- For children < 10 kg or < 1 year, the dose is 1.25 mg/kg/dose
- Administer at a concentration not to exceed 2 mg/mL. Doxorubicin (Adriamycin) should be administered through the tubing of rapidly infusing solution of D5W or 0.9% NaCl, and it should not be infused into a large vein
- Cyclophosphamide (Cytoxan) 1200 mg/m2/dose IV over 30 to60 minutes on day 1 of weeks 1, 5 and 9
- For children < 10 kg or < 1 year, the dose is 40 mg/kg/dose
- May be administered as undiluted drug (20 mg/mL, reconstitute with 0.9% NaCl to avoid hypotonic solution) or further diluted
- Mesna (Mesnex) 720 mg/m2/day by IV infusion or IV/PO with Cyclophosphamide (Cytoxan) on day 1 of weeks 1, 5 and 9
- For children < 10 kg or < 1 year, the dose is 24 mg/kg/dose
14 day cycle
Cycles 2, 4, & 6 (IE)
- Ifosfamide (Ifex) 1,800 mg/m2/dose IV infusion over 1 hour on days 1, 2, 3, 4, and 5 of Weeks 3, 7 and 11
- For children < 10 kg or < 1 year, the dose is 60 mg/kg/dose
- Achieve urine specific gravity ≤ 1.010 prior to start of Ifosfamide (Ifex).
- Mesna (Mesnex) 1,080 mg/m2/day by IV infusion or IV/PO with Ifosfamide (Ifex) on days 1, 2, 3, 4, and 5 of Weeks 3, 7 and 11
- For children < 10 kg or < 1 year, the dose is 36 mg/kg/dose
- Etoposide (Vepesid) 100 mg/m2/dose IV infusion over 1 to 2 hours once on days 1, 2, 3, 4, and 5 of weeks 3, 7 and 11
- For children < 10 kg or < 1 year, the dose is 3.3 mg/kg/dose
14 day cycle