Ewing sarcoma, pediatric - historical

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The purpose of this page is to provide references to regimens that are obsolete, outdated, or of historical interest only. As a general rule, this includes the inferior arm(s) of a randomized study, unless said regimens continue to be recommended by trustworthy sources such as the NCCN Guidelines. Is there a regimen missing from this list? See the main pediatric Ewing sarcoma page for current regimens.

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Upfront therapy, localized disease

COG AEWS0031 Induction A

Regimen

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

Chemotherapy, VDC portion

  • Vincristine (Oncovin) as follows:
    • Cycles 1 & 3: 2 mg/m2 IV push once on day 1 (maximum dose of 2 mg)
      • Treat with 50% doses calculated on a m2 basis for children < 1 year, then consider increasing to 75% and then to 100 % of calculated dose if tolerated
  • Doxorubicin (Adriamycin) as follows:
    • Cycles 1 & 3: 75 mg/m2 IV infusion over 48 hours once on day 1
      • Treat with 50% doses calculated on a m2 basis for children < 1 year, then consider increasing to 75% and then to 100 % of calculated dose if tolerated
  • Cyclophosphamide (Cytoxan) as follows:
    • Cycles 1 & 3: 1200 mg/m2 IV over 1 hour on Days 1
      • Treat with 50% doses calculated on a m2 basis for children < 1 year, then consider increasing to 75% and then to 100 % of calculated dose if tolerated

Supportive medications, VDC portion

21 day cycle

Chemotherapy, IE portion

  • Ifosfamide (Ifex) as follows:
    • Cycles 2 & 4: 1800 mg/m2 IV infusion over 1 hour once on day 1 to 5
      • Treat with 50% doses calculated on a m2 basis for children < 1 year, then consider increasing to 75% and then to 100 % of calculated dose if tolerated
  • Etoposide (Vepesid) as follows:
    • Cycles 2 & 4: 100 mg/m2 IV infusion over 1 to 2 hours once on days 1 to 5
      • Treat with 50% doses calculated on a m2 basis for children < 1 year, then consider increasing to 75% and then to 100 % of calculated dose if tolerated

Supportive medications, IE portion

  • Mesna (Mesnex) as follows:
  • Filgrastim (Neupogen) as follows:
    • Cycles 2 & 4: 5 mcg/kg SC for at least 7 days, or until ANC ≥ 750/μl, beginning on day 6
      • ANC ≥ 750/μl on or before day 7 of the cycle is not sufficient for discontinuing G-CSF

21 day cycle

References

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

COG AEWS0031 Continuation A

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

Regimen

Chemotherapy, VDC portion

Cycle 5 begins on week 15 in patients receiving surgery and on week 13 in Regimen A2
  • Vincristine (Oncovin) as follows:
    • Cycle 5 & 9: 2 mg/m2 IV push once on day 1 (maximum dose of 2 mg)
      • Treat with 50% doses calculated on a m2 basis for children < 1 year, then consider increasing to 75% and then to 100 % of calculated dose if tolerated
  • Doxorubicin (Adriamycin) as follows:
    • Cycle 5 & 9: 75 mg/m2 IV infusion over 48 hours once on day 1
      • Treat with 50% doses calculated on a m2 basis for children < 1 year, then consider increasing to 75% and then to 100 % of calculated dose if tolerated
  • Cyclophosphamide (Cytoxan) as follows:
    • Cycle 5 & 9: 1200 mg/m2 IV over 1 hour on Days 1
      • Treat with 50% doses calculated on a m2 basis for children < 1 year, then consider increasing to 75% and then to 100 % of calculated dose if tolerated

Supportive medication, VDC portion

21 day cycle

Chemotherapy, IE portion

  • Ifosfamide (Ifex) as follows:
    • Cycle 6, 8, 10, 12, & 14: 1800 mg/m2 IV infusion over 1 hour once on day 1 to 5
      • Treat with 50% doses calculated on a m2 basis for children < 1 year, then consider increasing to 75% and then to 100 % of calculated dose if tolerated
  • Etoposide (Vepesid) as follows:
    • Cycle 6, 8, 10, 12, & 14: 100 mg/m2 IV infusion over 1 to 2 hours once on days 1 to 5
      • Treat with 50% doses calculated on a m2 basis for children < 1 year, then consider increasing to 75% and then to 100 % of calculated dose if tolerated

Supportive medications, IE portion

  • Mesna (Mesnex) as follows:
  • Filgrastim (Neupogen) as follows:
    • Cycle 6, 8, 10, 12, & 14: 5 mcg/kg SC for at least 7 days, or until ANC ≥ 750/μl, beginning on day 6
      • ANC ≥ 750/μl on or before day 7 of the cycle is not sufficient for discontinuing G-CSF

21 day cycle

Chemotherapy, VDC portion Regimen A1 (Surgery Only)

  • Vincristine (Oncovin) as follows:
    • Cycle 7: 2 mg/m2 IV push once on day 1 (maximum dose of 2 mg)
      • Treat with 50% doses calculated on a m2 basis for children < 1 year, then consider increasing to 75% and then to 100 % of calculated dose if tolerated
  • Doxorubicin (Adriamycin) as follows:
    • Cycle 7: 75 mg/m2 IV infusion over 48 hours once on day 1
      • Treat with 50% doses calculated on a m2 basis for children < 1 year, then consider increasing to 75% and then to 100 % of calculated dose if tolerated
  • Cyclophosphamide (Cytoxan) as follows:
    • Cycle 7: 1200 mg/m2 IV over 1 hour on Days 1
      • Treat with 50% doses calculated on a m2 basis for children < 1 year, then consider increasing to 75% and then to 100 % of calculated dose if tolerated

Supportive therapy, VDC portion Regimen A1 (Surgery Only)

21 day cycle

Chemotherapy, VC portion Regimen A2 & A3 (Radiation w/ or w/o Surgery)

  • Vincristine (Oncovin) as follows:
    • Cycle 7: 2 mg/m2 IV push once on day 1 (maximum dose of 2 mg)
      • Treat with 50% doses calculated on a m2 basis for children < 1 year, then consider increasing to 75% and then to 100 % of calculated dose if tolerated
  • Cyclophosphamide (Cytoxan) as follows:
    • Cycle 7: 1200 mg/m2 IV over 1 hour on Days 1
      • Treat with 50% doses calculated on a m2 basis for children < 1 year, then consider increasing to 75% and then to 100 % of calculated dose if tolerated

Supportive medications, VC portion Regimen A2 & A3 (Radiation w/ or w/o Surgery)

21 day cycle

Chemotherapy, VC portion Regimen A1 (Surgery Only)

  • Vincristine (Oncovin) as follows:
    • Cycle 11: 2 mg/m2 IV push once on day 1 (maximum dose of 2 mg)
      • Treat with 50% doses calculated on a m2 basis for children < 1 year, then consider increasing to 75% and then to 100 % of calculated dose if tolerated
  • Cyclophosphamide (Cytoxan) as follows:
    • Cycle 11: 1200 mg/m2 IV over 1 hour on Days 1
      • Treat with 50% doses calculated on a m2 basis for children < 1 year, then consider increasing to 75% and then to 100 % of calculated dose if tolerated

Supportive medications, VC portion Regimen A1 (Surgery Only)

21 day cycle

Chemotherapy, VDC portion Regimen A2 & A3 (Radiation w/ or w/o Surgery)

  • Vincristine (Oncovin) as follows:
    • Cycle 11: 2 mg/m2 IV push once on day 1 (maximum dose of 2 mg)
      • Treat with 50% doses calculated on a m2 basis for children < 1 year, then consider increasing to 75% and then to 100 % of calculated dose if tolerated
  • Doxorubicin (Adriamycin) as follows:
    • Cycle 11: 75 mg/m2 IV infusion over 48 hours once on day 1
      • Treat with 50% doses calculated on a m2 basis for children < 1 year, then consider increasing to 75% and then to 100 % of calculated dose if tolerated
  • Cyclophosphamide (Cytoxan) as follows:
    • Cycle 11: 1200 mg/m2 IV over 1 hour on Days 1
      • Treat with 50% doses calculated on a m2 basis for children < 1 year, then consider increasing to 75% and then to 100 % of calculated dose if tolerated

Supportive medications, VDC portion Regimen A2 & A3 (Radiation w/ or w/o Surgery)

21 day cycle

Chemotherapy, VC portion

  • Vincristine (Oncovin) as follows:
    • Cycle 13: 2 mg/m2 IV push once on day 1 (maximum dose of 2 mg)
      • Treat with 50% doses calculated on a m2 basis for children < 1 year, then consider increasing to 75% and then to 100 % of calculated dose if tolerated
  • Cyclophosphamide (Cytoxan) as follows:
    • Cycle 13: 1200 mg/m2 IV over 1 hour on Days 1
      • Treat with 50% doses calculated on a m2 basis for children < 1 year, then consider increasing to 75% and then to 100 % of calculated dose if tolerated

Supportive medications, VC portion

21 day cycle

References

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

COG AEWS0031 Induction B

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

Regimen

Chemotherapy, VDC portion

  • Vincristine (Oncovin) as follows:
    • Cycles 1, 3, & 5: 2 mg/m2 IV push once on day 1 (maximum dose of 2 mg)
      • Treat with 50% doses calculated on a m2 basis for children < 1 year, then consider increasing to 75% and then to 100 % of calculated dose if tolerated
  • Doxorubicin (Adriamycin) as follows:
    • Cycles 1, 3, & 5: 75 mg/m2 IV infusion over 48 hours once on day 1
      • Treat with 50% doses calculated on a m2 basis for children < 1 year, then consider increasing to 75% and then to 100 % of calculated dose if tolerated
  • Cyclophosphamide (Cytoxan) as follows:
    • Cycles 1, 3, & 5: 1200 mg/m2 IV over 1 hour on Days 1
      • Treat with 50% doses calculated on a m2 basis for children < 1 year, then consider increasing to 75% and then to 100 % of calculated dose if tolerated

Supportive medications, VDC portion

14 day cycle

Chemotherapy, IE portion

  • Ifosfamide (Ifex) as follows:
    • Cycle 2, 4, & 6: 1800 mg/m2 IV infusion over 1 hour once on day 1 to 5
      • Treat with 50% doses calculated on a m2 basis for children < 1 year, then consider increasing to 75% and then to 100 % of calculated dose if tolerated
  • Etoposide (Vepesid) as follows:
    • Cycle 2, 4, & 6: 100 mg/m2 IV infusion over 1 to 2 hours once on days 1 to 5
      • Treat with 50% doses calculated on a m2 basis for children < 1 year, then consider increasing to 75% and then to 100 % of calculated dose if tolerated

Supportive medications, IE portion

  • Mesna (Mesnex) as follows:
  • Filgrastim (Neupogen) as follows:
    • Cycle 2, 4, & 6: 5 mcg/kg SC for at least 7 days, or until ANC ≥ 750/μl, beginning on day 6
      • ANC ≥ 750/μl on or before day 7 of the cycle is not sufficient for discontinuing G-CSF

14 day cycle

COG AEWS0031 Continuation B

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

Regimen

Chemotherapy, VDC portion

Cycle 7 begins on week 15 in patients receiving surgery and on week 13 in Regimen B2
  • Vincristine (Oncovin) as follows:
    • Cycle 7: 2 mg/m2 IV push once on day 1 (maximum dose of 2 mg)
      • Treat with 50% doses calculated on a m2 basis for children < 1 year, then consider increasing to 75% and then to 100 % of calculated dose if tolerated
  • Doxorubicin (Adriamycin) as follows:
    • Cycle 7: 75 mg/m2 IV infusion over 48 hours once on day 1
      • Treat with 50% doses calculated on a m2 basis for children < 1 year, then consider increasing to 75% and then to 100 % of calculated dose if tolerated
  • Cyclophosphamide (Cytoxan) as follows:
    • Cycle 7: 1200 mg/m2 IV over 1 hour on Days 1
      • Treat with 50% doses calculated on a m2 basis for children < 1 year, then consider increasing to 75% and then to 100 % of calculated dose if tolerated

Supportive medications, VDC portion

14 day cycle


Chemotherapy, IE portion

  • Ifosfamide (Ifex) as follows:
    • Cycle 8, 10, 12, & 14: 1800 mg/m2 IV infusion over 1 hour once on day 1 to 5
      • Treat with 50% doses calculated on a m2 basis for children < 1 year, then consider increasing to 75% and then to 100 % of calculated dose if tolerated
  • Etoposide (Vepesid) as follows:
    • Cycle 8, 10, 12, & 14: 100 mg/m2 IV infusion over 1 to 2 hours once on days 1 to 5
      • Treat with 50% doses calculated on a m2 basis for children < 1 year, then consider increasing to 75% and then to 100 % of calculated dose if tolerated

Supportive medications, IE portion

  • Mesna (Mesnex) as follows:
  • Filgrastim (Neupogen) as follows:
    • Cycle 8, 10, 12, & 14: 5 mcg/kg SC for at least 7 days, or until ANC ≥ 750/μl, beginning on day 6
      • ANC ≥ 750/μl on or before day 7 of the cycle is not sufficient for discontinuing G-CSF

14 day cycle

Chemotherapy, VDC portion Regimen B1 (Surgery Only)

  • Vincristine (Oncovin) as follows:
    • Cycle 9: 2 mg/m2 IV push once on day 1 (maximum dose of 2 mg)
      • Treat with 50% doses calculated on a m2 basis for children < 1 year, then consider increasing to 75% and then to 100 % of calculated dose if tolerated
  • Doxorubicin (Adriamycin) as follows:
    • Cycle 9: 75 mg/m2 IV infusion over 48 hours once on day 1
      • Treat with 50% doses calculated on a m2 basis for children < 1 year, then consider increasing to 75% and then to 100 % of calculated dose if tolerated
  • Cyclophosphamide (Cytoxan) as follows:
    • Cycle 9: 1200 mg/m2 IV over 1 hour on Days 1
      • Treat with 50% doses calculated on a m2 basis for children < 1 year, then consider increasing to 75% and then to 100 % of calculated dose if tolerated

Supportive medications, VDC portion Regimen B1 (Surgery Only)

14 day cycle

Chemotherapy, VC portion Regimen B2 & B3 (Radiation w/ or w/o Surgery)

  • Vincristine (Oncovin) as follows:
    • Cycle 9: 2 mg/m2 IV push once on day 1 (maximum dose of 2 mg)
      • Treat with 50% doses calculated on a m2 basis for children < 1 year, then consider increasing to 75% and then to 100 % of calculated dose if tolerated
  • Cyclophosphamide (Cytoxan) as follows:
    • Cycle 9: 1200 mg/m2 IV over 1 hour on Days 1
      • Treat with 50% doses calculated on a m2 basis for children < 1 year, then consider increasing to 75% and then to 100 % of calculated dose if tolerated

Supportive medications, VC portion Regimen B2 & B3 (Radiation w/ or w/o Surgery)

14 day cycle

Chemotherapy, VC portion

  • Vincristine (Oncovin) as follows:
    • Cycle 11: 2 mg/m2 IV push once on day 1 (maximum dose of 2 mg)
      • Treat with 50% doses calculated on a m2 basis for children < 1 year, then consider increasing to 75% and then to 100 % of calculated dose if tolerated
  • Cyclophosphamide (Cytoxan) as follows:
    • Cycle 11: 1200 mg/m2 IV over 1 hour on Days 1
      • Treat with 50% doses calculated on a m2 basis for children < 1 year, then consider increasing to 75% and then to 100 % of calculated dose if tolerated

Supportive medications, VC portion

14 day cycle

Chemotherapy, VC portion Regimen B1 (Surgery Only)

  • Vincristine (Oncovin) as follows:
    • Cycle 13: 2 mg/m2 IV push once on day 1 (maximum dose of 2 mg)
      • Treat with 50% doses calculated on a m2 basis for children < 1 year, then consider increasing to 75% and then to 100 % of calculated dose if tolerated
  • Cyclophosphamide (Cytoxan) as follows:
    • Cycle 13: 1200 mg/m2 IV over 1 hour on Days 1
      • Treat with 50% doses calculated on a m2 basis for children < 1 year, then consider increasing to 75% and then to 100 % of calculated dose if tolerated

Supportive medications, VC portion Regimen B1 (Surgery Only)

14 day cycle

Chemotherapy, VDC portion Regimen B2 & B3 (Radiation w/ or w/o Surgery)

  • Vincristine (Oncovin) as follows:
    • Cycle 13: 2 mg/m2 IV push once on day 1 (maximum dose of 2 mg)
      • Treat with 50% doses calculated on a m2 basis for children < 1 year, then consider increasing to 75% and then to 100 % of calculated dose if tolerated
  • Doxorubicin (Adriamycin) as follows:
    • Cycle 13: 75 mg/m2 IV infusion over 48 hours once on day 1
      • Treat with 50% doses calculated on a m2 basis for children < 1 year, then consider increasing to 75% and then to 100 % of calculated dose if tolerated
  • Cyclophosphamide (Cytoxan) as follows:
    • Cycle 13: 1200 mg/m2 IV over 1 hour on Days 1
      • Treat with 50% doses calculated on a m2 basis for children < 1 year, then consider increasing to 75% and then to 100 % of calculated dose if tolerated

Supportive medications, VDC portion Regimen B2 & B3 (Radiation w/ or w/o Surgery)

14 day cycle

References

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