Rhabdomyosarcoma, pediatric - historical

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The purpose of this page is to provide references to regimens that are obsolete, outdated, or of historical interest only.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

1 regimens on this page 1 variants on this page

High Risk

COG D9802 VCPT Alternating with VAC Arm

Irinotecan Window

Week 0 (VCPT)

• 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
• Irinotecan (Camptosar) 50 mg/m² (maximum dose of 40 mg/day) IV over 60 minutes once per day on days 1 through 5
  • Irinotecan (Camptosar) to be given after Vincristine (Oncovin)

Week 1 (VCPT)

• 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
• Irinotecan (Camptosar) 50 mg/m² (maximum dose of 40 mg/day) IV over 60 minutes once per day on days 1 through 5
  • Irinotecan (Camptosar) to be given after Vincristine (Oncovin)

Week 3 (VCPT)

• 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
• Irinotecan (Camptosar) 50 mg/m² (maximum dose of 40 mg/day) IV over 60 minutes once per day on days 1 through 5
  • Irinotecan (Camptosar) to be given after Vincristine (Oncovin)

Week 4 (VCPT)

• 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
• Irinotecan (Camptosar) 50 mg/m² (maximum dose of 40 mg/day) IV over 60 minutes once per day on days 1 through 5
  • Irinotecan (Camptosar) to be given after Vincristine (Oncovin)

Induction

Week 6 (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: 2.2 g/m² IV infusion over 30 to 60 minutes once per day on day 1
  • Age ≥ 1 year: 73 mg/kg IV infusion over 30 to 60 minutes once on day 1
  • Age < 1 year: 36 mg/kg IV infusion over 30 to 60 minutes once on day 1
• Mesna (Mesnex) by the following age-based criteria:
  • Age ≥ 3 years: 440 mg/m² IV infusion at hour 0, 4, and 8 from the start of each Cyclophosphamide (Cytoxan) infusion on day 1
  • Age ≥ 1 year: 14.6 mg/m² IV infusion at hour 0, 4, and 8 from the start of each Cyclophosphamide (Cytoxan) infusion on day 1
  • Age < 1 year: 7.2 mg/m² IV infusion at hour 0, 4, and 8 from the start of each Cyclophosphamide (Cytoxan) infusion on day 1

Week 7 (Vincristine)

• 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 8 (Vincristine)

• 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 (VCPT)

• 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
• Irinotecan (Camptosar) 50 mg/m² (maximum dose of 40 mg/day) IV over 60 minutes once per day on days 1 through 5
  • Irinotecan (Camptosar) to be given after Vincristine (Oncovin)

Week 10 (VCPT)

• 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
• Irinotecan (Camptosar) 50 mg/m² (maximum dose of 40 mg/day) IV over 60 minutes once per day on days 1 through 5
  • Irinotecan (Camptosar) to be given after Vincristine (Oncovin)

Week 11 (Vincristine)

• 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 12 (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: 2.2 g/m² IV infusion over 30 to 60 minutes once per day on day 1
  • Age ≥ 1 year: 73 mg/kg IV infusion over 30 to 60 minutes once on day 1
  • Age < 1 year: 36 mg/kg IV infusion over 30 to 60 minutes once on day 1
• Mesna (Mesnex) by the following age-based criteria:
  • Age ≥ 3 years: 440 mg/m² IV infusion at hour 0, 4, and 8 from the start of each Cyclophosphamide (Cytoxan) infusion on day 1
  • Age ≥ 1 year: 14.6 mg/m² IV infusion at hour 0, 4, and 8 from the start of each Cyclophosphamide (Cytoxan) infusion on day 1
  • Age < 1 year: 7.2 mg/m² IV infusion at hour 0, 4, and 8 from the start of each Cyclophosphamide (Cytoxan) infusion on day 1

Week 13 (Vincristine)

• 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 15 (Vincristine)

• 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 16 (VC)

• 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
• Cyclophosphamide (Cytoxan) by the following age-based criteria:
  • Age ≥ 3 years: 2.2 g/m² IV infusion over 30 to 60 minutes once per day on day 1
  • Age ≥ 1 year: 73 mg/kg IV infusion over 30 to 60 minutes once on day 1
  • Age < 1 year: 36 mg/kg IV infusion over 30 to 60 minutes once on day 1
• Mesna (Mesnex) by the following age-based criteria:
  • Age ≥ 3 years: 440 mg/m² IV infusion at hour 0, 4, and 8 from the start of each Cyclophosphamide (Cytoxan) infusion on day 1
  • Age ≥ 1 year: 14.6 mg/m² IV infusion at hour 0, 4, and 8 from the start of each Cyclophosphamide (Cytoxan) infusion on day 1
  • Age < 1 year: 7.2 mg/m² IV infusion at hour 0, 4, and 8 from the start of each Cyclophosphamide (Cytoxan) infusion on day 1

Week 17 (Vincristine)

• 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 18 (Vincristine)

• 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 19 (VC)

• 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
• Cyclophosphamide (Cytoxan) by the following age-based criteria:
  • Age ≥ 3 years: 2.2 g/m² IV infusion over 30 to 60 minutes once per day on day 1
  • Age ≥ 1 year: 73 mg/kg IV infusion over 30 to 60 minutes once on day 1
  • Age < 1 year: 36 mg/kg IV infusion over 30 to 60 minutes once on day 1
• Mesna (Mesnex) by the following age-based criteria:
  • Age ≥ 3 years: 440 mg/m² IV infusion at hour 0, 4, and 8 from the start of each Cyclophosphamide (Cytoxan) infusion on day 1
  • Age ≥ 1 year: 14.6 mg/m² IV infusion at hour 0, 4, and 8 from the start of each Cyclophosphamide (Cytoxan) infusion on day 1
  • Age < 1 year: 7.2 mg/m² IV infusion at hour 0, 4, and 8 from the start of each Cyclophosphamide (Cytoxan) infusion on day 1

Week 23 (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: 2.2 g/m² IV infusion over 30 to 60 minutes once per day on day 1
  • Age ≥ 1 year: 73 mg/kg IV infusion over 30 to 60 minutes once on day 1
  • Age < 1 year: 36 mg/kg IV infusion over 30 to 60 minutes once on day 1
• Mesna (Mesnex) by the following age-based criteria:
  • Age ≥ 3 years: 440 mg/m² IV infusion at hour 0, 4, and 8 from the start of each Cyclophosphamide (Cytoxan) infusion on day 1
  • Age ≥ 1 year: 14.6 mg/m² IV infusion at hour 0, 4, and 8 from the start of each Cyclophosphamide (Cytoxan) infusion on day 1
  • Age < 1 year: 7.2 mg/m² IV infusion at hour 0, 4, and 8 from the start of each Cyclophosphamide (Cytoxan) infusion on day 1

Week 24 (Vincristine)

• 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 (Eval/Vincristine)

• Evaluation Week
• 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

Continuation

Week 26 (VCPT)

• 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
• Irinotecan (Camptosar) 50 mg/m² (maximum dose of 40 mg/day) IV over 60 minutes once per day on days 1 through 5
  • Irinotecan (Camptosar) to be given after Vincristine (Oncovin)

Week 27 (VCPT)

• 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
• Irinotecan (Camptosar) 50 mg/m² (maximum dose of 40 mg/day) IV over 60 minutes once per day on days 1 through 5
  • Irinotecan (Camptosar) to be given after Vincristine (Oncovin)

Week 29 (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: 2.2 g/m² IV infusion over 30 to 60 minutes once per day on day 1
  • Age ≥ 1 year: 73 mg/kg IV infusion over 30 to 60 minutes once on day 1
  • Age < 1 year: 36 mg/kg IV infusion over 30 to 60 minutes once on day 1
• Mesna (Mesnex) by the following age-based criteria:
  • Age ≥ 3 years: 440 mg/m² IV infusion at hour 0, 4, and 8 from the start of each Cyclophosphamide (Cytoxan) infusion on day 1
  • Age ≥ 1 year: 14.6 mg/m² IV infusion at hour 0, 4, and 8 from the start of each Cyclophosphamide (Cytoxan) infusion on day 1
  • Age < 1 year: 7.2 mg/m² IV infusion at hour 0, 4, and 8 from the start of each Cyclophosphamide (Cytoxan) infusion on day 1

Week 32 (VCPT)

• 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
• Irinotecan (Camptosar) 50 mg/m² (maximum dose of 40 mg/day) IV over 60 minutes once per day on days 1 through 5
  • Irinotecan (Camptosar) to be given after Vincristine (Oncovin)

Week 33 (VCPT)

• 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
• Irinotecan (Camptosar) 50 mg/m² (maximum dose of 40 mg/day) IV over 60 minutes once per day on days 1 through 5
  • Irinotecan (Camptosar) to be given after Vincristine (Oncovin)

Week 34 (Vincristine)

• 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 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: 2.2 g/m² IV infusion over 30 to 60 minutes once per day on day 1
  • Age ≥ 1 year: 73 mg/kg IV infusion over 30 to 60 minutes once on day 1
  • Age < 1 year: 36 mg/kg IV infusion over 30 to 60 minutes once on day 1
• Mesna (Mesnex) by the following age-based criteria:
  • Age ≥ 3 years: 440 mg/m² IV infusion at hour 0, 4, and 8 from the start of each Cyclophosphamide (Cytoxan) infusion on day 1
  • Age ≥ 1 year: 14.6 mg/m² IV infusion at hour 0, 4, and 8 from the start of each Cyclophosphamide (Cytoxan) infusion on day 1
  • Age < 1 year: 7.2 mg/m² IV infusion at hour 0, 4, and 8 from the start of each Cyclophosphamide (Cytoxan) infusion on day 1

Week 38 (VCPT)

• 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
• Irinotecan (Camptosar) 50 mg/m² (maximum dose of 40 mg/day) IV over 60 minutes once per day on days 1 through 5
  • Irinotecan (Camptosar) to be given after Vincristine (Oncovin)

Week 39 (VCPT)

• 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
• Irinotecan (Camptosar) 50 mg/m² (maximum dose of 40 mg/day) IV over 60 minutes once per day on days 1 through 5
  • Irinotecan (Camptosar) to be given after Vincristine (Oncovin)

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: 2.2 g/m² IV infusion over 30 to 60 minutes once per day on day 1
  • Age ≥ 1 year: 73 mg/kg IV infusion over 30 to 60 minutes once on day 1
  • Age < 1 year: 36 mg/kg IV infusion over 30 to 60 minutes once on day 1
• Mesna (Mesnex) by the following age-based criteria:
  • Age ≥ 3 years: 440 mg/m² IV infusion at hour 0, 4, and 8 from the start of each Cyclophosphamide (Cytoxan) infusion on day 1
  • Age ≥ 1 year: 14.6 mg/m² IV infusion at hour 0, 4, and 8 from the start of each Cyclophosphamide (Cytoxan) infusion on day 1
  • Age < 1 year: 7.2 mg/m² IV infusion at hour 0, 4, and 8 from the start of each Cyclophosphamide (Cytoxan) infusion on day 1

References

1. COG D9802: Pappo AS, Lyden E, Breitfeld P, Donaldson SS, Wiener E, Parham D, Crews KR, Houghton P, Meyer WH. Two Consecutive Phase II Window Trials of Irinotecan Alone or in Combination With vincristine for the Treatment of Metastatic Rhabdomyosarcoma: The Children's Oncology Group. Journal of Clinical Oncology. 2007 Feb;25(4):362-369. link to original article PubMed NCT00003955

COG D9802 VAC Alone Arm

Irinotecan Window

Week 0 (VCPT)

• 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
• Irinotecan (Camptosar) 50 mg/m² (maximum dose of 40 mg/day) IV over 60 minutes once per day on days 1 through 5
  • Irinotecan (Camptosar) to be given after Vincristine (Oncovin)

Week 1 (VCPT)

• 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
• Irinotecan (Camptosar) 50 mg/m² (maximum dose of 40 mg/day) IV over 60 minutes once per day on days 1 through 5
  • Irinotecan (Camptosar) to be given after Vincristine (Oncovin)

Week 3 (VCPT)

• 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
• Irinotecan (Camptosar) 50 mg/m² (maximum dose of 40 mg/day) IV over 60 minutes once per day on days 1 through 5
  • Irinotecan (Camptosar) to be given after Vincristine (Oncovin)

Week 4 (VCPT)

• 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
• Irinotecan (Camptosar) 50 mg/m² (maximum dose of 40 mg/day) IV over 60 minutes once per day on days 1 through 5
  • Irinotecan (Camptosar) to be given after Vincristine (Oncovin)

Induction

Week 6 (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: 2.2 g/m² IV infusion over 30 to 60 minutes once per day on day 1
  • Age ≥ 1 year: 73 mg/kg IV infusion over 30 to 60 minutes once on day 1
  • Age < 1 year: 36 mg/kg IV infusion over 30 to 60 minutes once on day 1
• Mesna (Mesnex) by the following age-based criteria:
  • Age ≥ 3 years: 440 mg/m² IV infusion at hour 0, 4, and 8 from the start of each Cyclophosphamide (Cytoxan) infusion on day 1
  • Age ≥ 1 year: 14.6 mg/m² IV infusion at hour 0, 4, and 8 from the start of each Cyclophosphamide (Cytoxan) infusion on day 1
  • Age < 1 year: 7.2 mg/m² IV infusion at hour 0, 4, and 8 from the start of each Cyclophosphamide (Cytoxan) infusion on day 1

Week 7 (Vincristine)

• 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 8 (Vincristine)

• 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 (VCPT)

• 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
• Irinotecan (Camptosar) 50 mg/m² (maximum dose of 40 mg/day) IV over 60 minutes once per day on days 1 through 5
  • Irinotecan (Camptosar) to be given after Vincristine (Oncovin)

Week 10 (VCPT)

• 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
• Irinotecan (Camptosar) 50 mg/m² (maximum dose of 40 mg/day) IV over 60 minutes once per day on days 1 through 5
  • Irinotecan (Camptosar) to be given after Vincristine (Oncovin)

Week 11 (Vincristine)

• 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 12 (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: 2.2 g/m² IV infusion over 30 to 60 minutes once per day on day 1
  • Age ≥ 1 year: 73 mg/kg IV infusion over 30 to 60 minutes once on day 1
  • Age < 1 year: 36 mg/kg IV infusion over 30 to 60 minutes once on day 1
• Mesna (Mesnex) by the following age-based criteria:
  • Age ≥ 3 years: 440 mg/m² IV infusion at hour 0, 4, and 8 from the start of each Cyclophosphamide (Cytoxan) infusion on day 1
  • Age ≥ 1 year: 14.6 mg/m² IV infusion at hour 0, 4, and 8 from the start of each Cyclophosphamide (Cytoxan) infusion on day 1
  • Age < 1 year: 7.2 mg/m² IV infusion at hour 0, 4, and 8 from the start of each Cyclophosphamide (Cytoxan) infusion on day 1

Week 13 (Vincristine)

• 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 15 (Vincristine)

• 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 16 (VC)

• 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
• Cyclophosphamide (Cytoxan) by the following age-based criteria:
  • Age ≥ 3 years: 2.2 g/m² IV infusion over 30 to 60 minutes once per day on day 1
  • Age ≥ 1 year: 73 mg/kg IV infusion over 30 to 60 minutes once on day 1
  • Age < 1 year: 36 mg/kg IV infusion over 30 to 60 minutes once on day 1
• Mesna (Mesnex) by the following age-based criteria:
  • Age ≥ 3 years: 440 mg/m² IV infusion at hour 0, 4, and 8 from the start of each Cyclophosphamide (Cytoxan) infusion on day 1
  • Age ≥ 1 year: 14.6 mg/m² IV infusion at hour 0, 4, and 8 from the start of each Cyclophosphamide (Cytoxan) infusion on day 1
  • Age < 1 year: 7.2 mg/m² IV infusion at hour 0, 4, and 8 from the start of each Cyclophosphamide (Cytoxan) infusion on day 1

Week 17 (Vincristine)

• 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 18 (Vincristine)

• 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 19 (VC)

• 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
• Cyclophosphamide (Cytoxan) by the following age-based criteria:
  • Age ≥ 3 years: 2.2 g/m² IV infusion over 30 to 60 minutes once per day on day 1
  • Age ≥ 1 year: 73 mg/kg IV infusion over 30 to 60 minutes once on day 1
  • Age < 1 year: 36 mg/kg IV infusion over 30 to 60 minutes once on day 1
• Mesna (Mesnex) by the following age-based criteria:
  • Age ≥ 3 years: 440 mg/m² IV infusion at hour 0, 4, and 8 from the start of each Cyclophosphamide (Cytoxan) infusion on day 1
  • Age ≥ 1 year: 14.6 mg/m² IV infusion at hour 0, 4, and 8 from the start of each Cyclophosphamide (Cytoxan) infusion on day 1
  • Age < 1 year: 7.2 mg/m² IV infusion at hour 0, 4, and 8 from the start of each Cyclophosphamide (Cytoxan) infusion on day 1

Week 23 (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: 2.2 g/m² IV infusion over 30 to 60 minutes once per day on day 1
  • Age ≥ 1 year: 73 mg/kg IV infusion over 30 to 60 minutes once on day 1
  • Age < 1 year: 36 mg/kg IV infusion over 30 to 60 minutes once on day 1
• Mesna (Mesnex) by the following age-based criteria:
  • Age ≥ 3 years: 440 mg/m² IV infusion at hour 0, 4, and 8 from the start of each Cyclophosphamide (Cytoxan) infusion on day 1
  • Age ≥ 1 year: 14.6 mg/m² IV infusion at hour 0, 4, and 8 from the start of each Cyclophosphamide (Cytoxan) infusion on day 1
  • Age < 1 year: 7.2 mg/m² IV infusion at hour 0, 4, and 8 from the start of each Cyclophosphamide (Cytoxan) infusion on day 1

Week 24 (Vincristine)

• 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 (Evaluation/Vincristine)

• 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

Continuation

Week 26 (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: 2.2 g/m² IV infusion over 30 to 60 minutes once per day on day 1
  • Age ≥ 1 year: 73 mg/kg IV infusion over 30 to 60 minutes once on day 1
  • Age < 1 year: 36 mg/kg IV infusion over 30 to 60 minutes once on day 1
• Mesna (Mesnex) by the following age-based criteria:
  • Age ≥ 3 years: 440 mg/m² IV infusion at hour 0, 4, and 8 from the start of each Cyclophosphamide (Cytoxan) infusion on day 1
  • Age ≥ 1 year: 14.6 mg/m² IV infusion at hour 0, 4, and 8 from the start of each Cyclophosphamide (Cytoxan) infusion on day 1
  • Age < 1 year: 7.2 mg/m² IV infusion at hour 0, 4, and 8 from the start of each Cyclophosphamide (Cytoxan) infusion on day 1

Week 27 (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 29 (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: 2.2 g/m² IV infusion over 30 to 60 minutes once per day on day 1
  • Age ≥ 1 year: 73 mg/kg IV infusion over 30 to 60 minutes once on day 1
  • Age < 1 year: 36 mg/kg IV infusion over 30 to 60 minutes once on day 1
• Mesna (Mesnex) by the following age-based criteria:
  • Age ≥ 3 years: 440 mg/m² IV infusion at hour 0, 4, and 8 from the start of each Cyclophosphamide (Cytoxan) infusion on day 1
  • Age ≥ 1 year: 14.6 mg/m² IV infusion at hour 0, 4, and 8 from the start of each Cyclophosphamide (Cytoxan) infusion on day 1
  • Age < 1 year: 7.2 mg/m² IV infusion at hour 0, 4, and 8 from the start of each Cyclophosphamide (Cytoxan) infusion on day 1

Week 32 (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: 2.2 g/m² IV infusion over 30 to 60 minutes once per day on day 1
  • Age ≥ 1 year: 73 mg/kg IV infusion over 30 to 60 minutes once on day 1
  • Age < 1 year: 36 mg/kg IV infusion over 30 to 60 minutes once on day 1
• Mesna (Mesnex) by the following age-based criteria:
  • Age ≥ 3 years: 440 mg/m² IV infusion at hour 0, 4, and 8 from the start of each Cyclophosphamide (Cytoxan) infusion on day 1
  • Age ≥ 1 year: 14.6 mg/m² IV infusion at hour 0, 4, and 8 from the start of each Cyclophosphamide (Cytoxan) infusion on day 1
  • Age < 1 year: 7.2 mg/m² IV infusion at hour 0, 4, and 8 from the start of each Cyclophosphamide (Cytoxan) infusion on day 1

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 (Vincristine)

• 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 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: 2.2 g/m² IV infusion over 30 to 60 minutes once per day on day 1
  • Age ≥ 1 year: 73 mg/kg IV infusion over 30 to 60 minutes once on day 1
  • Age < 1 year: 36 mg/kg IV infusion over 30 to 60 minutes once on day 1
• Mesna (Mesnex) by the following age-based criteria:
  • Age ≥ 3 years: 440 mg/m² IV infusion at hour 0, 4, and 8 from the start of each Cyclophosphamide (Cytoxan) infusion on day 1
  • Age ≥ 1 year: 14.6 mg/m² IV infusion at hour 0, 4, and 8 from the start of each Cyclophosphamide (Cytoxan) infusion on day 1
  • Age < 1 year: 7.2 mg/m² IV infusion at hour 0, 4, and 8 from the start of each Cyclophosphamide (Cytoxan) infusion on day 1

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: 2.2 g/m² IV infusion over 30 to 60 minutes once per day on day 1
  • Age ≥ 1 year: 73 mg/kg IV infusion over 30 to 60 minutes once on day 1
  • Age < 1 year: 36 mg/kg IV infusion over 30 to 60 minutes once on day 1
• Mesna (Mesnex) by the following age-based criteria:
  • Age ≥ 3 years: 440 mg/m² IV infusion at hour 0, 4, and 8 from the start of each Cyclophosphamide (Cytoxan) infusion on day 1
  • Age ≥ 1 year: 14.6 mg/m² IV infusion at hour 0, 4, and 8 from the start of each Cyclophosphamide (Cytoxan) infusion on day 1
  • Age < 1 year: 7.2 mg/m² IV infusion at hour 0, 4, and 8 from the start of each Cyclophosphamide (Cytoxan) infusion on day 1

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: 2.2 g/m² IV infusion over 30 to 60 minutes once per day on day 1
  • Age ≥ 1 year: 73 mg/kg IV infusion over 30 to 60 minutes once on day 1
  • Age < 1 year: 36 mg/kg IV infusion over 30 to 60 minutes once on day 1
• Mesna (Mesnex) by the following age-based criteria:
  • Age ≥ 3 years: 440 mg/m² IV infusion at hour 0, 4, and 8 from the start of each Cyclophosphamide (Cytoxan) infusion on day 1
  • Age ≥ 1 year: 14.6 mg/m² IV infusion at hour 0, 4, and 8 from the start of each Cyclophosphamide (Cytoxan) infusion on day 1
  • Age < 1 year: 7.2 mg/m² IV infusion at hour 0, 4, and 8 from the start of each Cyclophosphamide (Cytoxan) infusion on day 1

References

1. COG D9802: Pappo AS, Lyden E, Breitfeld P, Donaldson SS, Wiener E, Parham D, Crews KR, Houghton P, Meyer WH. Two Consecutive Phase II Window Trials of Irinotecan Alone or in Combination With vincristine for the Treatment of Metastatic Rhabdomyosarcoma: The Children's Oncology Group. Journal of Clinical Oncology. 2007 Feb;25(4):362-369. link to original article PubMed NCT00003955

Low Risk

COG D9602 Subgroup A

Chemotherapy

• 4 12-week cycles beginning on weeks 0, 12, 24, 36

Week 0

• 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

Week 1

• 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 2

• 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

• 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
• External beam radiotherapy by the following protocol based criteria (see full protocol for criteria) beginning after Dactinomycin (Cosmegen):
  • Clinical Group I: No XRT
  • Clinical Group II: 36 Gy given once daily in 20 divided fractions
  • Clinical Group III: 45 Gy given once daily in 25 divided fractions

Week 4

• 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 5

• 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

• 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
• For Clinical Group I who do no receive radiotherapy, give 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
• If radiotherapy is given (Clinical Groups II and III) no Dactinomycin (Cosmegen) should be given during week 6

Week 7

• 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 8

• 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

• 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

COG D9602 Subgroup B

Chemotherapy

• 4 12-week cycles beginning on weeks 0, 12, 24, 36

Week 0

• 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: 2.2 g/m² IV infusion over 30 to 60 minutes once per day on day 1
  • Age ≥ 1 year: 73 mg/kg IV infusion over 30 to 60 minutes once on day 1
  • Age < 1 year: 36 mg/kg IV infusion over 30 to 60 minutes once on day 1
• Mesna (Mesnex) by the following age-based criteria:
  • Age ≥ 3 years: 440 mg/m² IV infusion at hour 0, 4, and 8 from the start of each Cyclophosphamide (Cytoxan) infusion on day 1
  • Age ≥ 1 year: 14.6 mg/m² IV infusion at hour 0, 4, and 8 from the start of each Cyclophosphamide (Cytoxan) infusion on day 1
  • Age < 1 year: 7.2 mg/m² IV infusion at hour 0, 4, and 8 from the start of each Cyclophosphamide (Cytoxan) infusion on day 1
• Filgrastim (Neupogen) 5 μg/kg SubQ or IV (per institutional policy) once daily starting 24 hours after VAC completion and continued once daily for 10 days or until ANC > 2000/μL

Week 1

• 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 2

• 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

• 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: 2.2 g/m² IV infusion over 30 to 60 minutes once per day on day 1
  • Age ≥ 1 year: 73 mg/kg IV infusion over 30 to 60 minutes once on day 1
  • Age < 1 year: 36 mg/kg IV infusion over 30 to 60 minutes once on day 1
• Mesna (Mesnex) by the following age-based criteria:
  • Age ≥ 3 years: 440 mg/m² IV infusion at hour 0, 4, and 8 from the start of each Cyclophosphamide (Cytoxan) infusion on day 1
  • Age ≥ 1 year: 14.6 mg/m² IV infusion at hour 0, 4, and 8 from the start of each Cyclophosphamide (Cytoxan) infusion on day 1
  • Age < 1 year: 7.2 mg/m² IV infusion at hour 0, 4, and 8 from the start of each Cyclophosphamide (Cytoxan) infusion on day 1
• External beam radiotherapy by the following protocol based criteria (see full protocol for criteria) beginning after Dactinomycin (Cosmegen):
  • Clinical Group I: No XRT
  • Clinical Group II: 36 Gy given once daily in 20 divided fractions
  • Clinical Group III: 45 Gy given once daily in 25 divided fractions
• Filgrastim (Neupogen) 5 μg/kg SubQ or IV (per institutional policy) once daily starting 24 hours after VAC completion and continued once daily for 10 days or until ANC > 2000/μL

Week 4

• 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 5

• 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

• 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
• For Clinical Group I who do no receive radiotherapy, give 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
• If radiotherapy is given (Clinical Groups II and III) no Dactinomycin (Cosmegen) should be given during week 6
• Cyclophosphamide (Cytoxan) by the following age-based criteria:
  • Age ≥ 3 years: 2.2 g/m² IV infusion over 30 to 60 minutes once per day on day 1
  • Age ≥ 1 year: 73 mg/kg IV infusion over 30 to 60 minutes once on day 1
  • Age < 1 year: 36 mg/kg IV infusion over 30 to 60 minutes once on day 1
• Mesna (Mesnex) by the following age-based criteria:
  • Age ≥ 3 years: 440 mg/m² IV infusion at hour 0, 4, and 8 from the start of each Cyclophosphamide (Cytoxan) infusion on day 1
  • Age ≥ 1 year: 14.6 mg/m² IV infusion at hour 0, 4, and 8 from the start of each Cyclophosphamide (Cytoxan) infusion on day 1
  • Age < 1 year: 7.2 mg/m² IV infusion at hour 0, 4, and 8 from the start of each Cyclophosphamide (Cytoxan) infusion on day 1
• Filgrastim (Neupogen) 5 μg/kg SubQ or IV (per institutional policy) once daily starting 24 hours after VAC completion and continued once daily for 10 days or until ANC > 2000/μL

Week 7

• 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 8

• 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

• 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: 2.2 g/m² IV infusion over 30 to 60 minutes once per day on day 1
  • Age ≥ 1 year: 73 mg/kg IV infusion over 30 to 60 minutes once on day 1
  • Age < 1 year: 36 mg/kg IV infusion over 30 to 60 minutes once on day 1
• Mesna (Mesnex) by the following age-based criteria:
  • Age ≥ 3 years: 440 mg/m² IV infusion at hour 0, 4, and 8 from the start of each Cyclophosphamide (Cytoxan) infusion on day 1
  • Age ≥ 1 year: 14.6 mg/m² IV infusion at hour 0, 4, and 8 from the start of each Cyclophosphamide (Cytoxan) infusion on day 1
  • Age < 1 year: 7.2 mg/m² IV infusion at hour 0, 4, and 8 from the start of each Cyclophosphamide (Cytoxan) infusion on day 1
• Filgrastim (Neupogen) 5 μg/kg SubQ or IV (per institutional policy) once daily starting 24 hours after AC completion and continued once daily for 10 days or until ANC > 2000/μL

References

1. COG D9602: Raney RB, Walterhouse DO, Meza JL, Andrassy RJ, Breneman JC, Crist WM, Maurer HM, Parham DM, Anderson JR. Results of the Intergroup Rhabdomyosarcoma Study Group D9602 protocol, using vincristine and dactinomycin with or without cyclophosphamide and radiation therapy, for newly diagnosed patients with low-risk embryonal rhabdomyosarcoma: a report from the Soft Tissue Sarcoma Committee of the Children's Oncology Group. Journal of Clinical Oncology. 2011 Apr 1;29(10):1312-1318. link to original article PubMed PMC Full Text NCT00002995