Ewing sarcoma, pediatric - historical
Revision as of 00:31, 22 September 2022 by Warner-admin (talk | contribs) (Text replacement - "====References====" to "===References===")
The purpose of this page is to provide references to regimens that are obsolete, outdated, or of historical interest only.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.
0 regimens on this page
0 variants on this page
|
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
- Cycles 1 & 3: 2 mg/m2 IV push once on day 1 (maximum dose of 2 mg)
- 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
- Cycles 1 & 3: 75 mg/m2 IV infusion over 48 hours once on day 1
- 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
- Cycles 1 & 3: 1200 mg/m2 IV over 1 hour on Days 1
Supportive medications, VDC portion
- Mesna (Mesnex) as follows:
- Cycles 1 & 3: 720 mg/m2 IV continuous infusion on day 1
- NOTE: Protocol states that Mesna (Mesnex) should be dosed as AT LEAST 60% of Cyclophosphamide (Cytoxan) m2
- Mesna (Mesnex) continuous infusion should be started at the same time as the Cyclophosphamide (Cytoxan) and remain until at least 8 hours after the end of the Cyclophosphamide (Cytoxan) infusion
- Cycles 1 & 3: 720 mg/m2 IV continuous infusion on day 1
- Filgrastim (Neupogen) as follows:
- Cycles 1 & 3: 5 mcg/kg SC for at least 7 days, or until ANC ≥ 750/μl, beginning on day 2
- ANC ≥ 750/μl on or before day 7 of the cycle is not sufficient for discontinuing G-CSF
- Cycles 1 & 3: 5 mcg/kg SC for at least 7 days, or until ANC ≥ 750/μl, beginning on day 2
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
- Cycles 2 & 4: 1800 mg/m2 IV infusion over 1 hour once on day 1 to 5
- 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
- Cycles 2 & 4: 100 mg/m2 IV infusion over 1 to 2 hours once on days 1 to 5
Supportive medications, IE portion
- Mesna (Mesnex) as follows:
- Cycles 2 & 4: 1080 mg/m2 IV continuous infusion on day 1
- NOTE: Protocol states that Mesna (Mesnex) should be dosed as AT LEAST 60% of Ifosfamide (Ifex) m2
- Mesna (Mesnex) continuous infusion should be started at the same time as the Ifosfamide (Ifex) and remain until at least 8 hours after the end of the Ifosfamide (Ifex) infusion
- Cycles 2 & 4: 1080 mg/m2 IV continuous infusion on day 1
- 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
- Cycles 2 & 4: 5 mcg/kg SC for at least 7 days, or until ANC ≥ 750/μl, beginning on day 6
21 day cycle
References
- 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
- Cycle 5 & 9: 2 mg/m2 IV push once on day 1 (maximum dose of 2 mg)
- 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
- Cycle 5 & 9: 75 mg/m2 IV infusion over 48 hours once on day 1
- 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
- Cycle 5 & 9: 1200 mg/m2 IV over 1 hour on Days 1
Supportive medication, VDC portion
- Mesna (Mesnex) as follows:
- Cycle 5 & 9: 720 mg/m2 IV continuous infusion on day 1
- NOTE: Protocol states that Mesna (Mesnex) should be dosed as AT LEAST 60% of Cyclophosphamide (Cytoxan) m2
- Mesna (Mesnex) continuous infusion should be started at the same time as the Cyclophosphamide (Cytoxan) and remain until at least 8 hours after the end of the Cyclophosphamide (Cytoxan) infusion
- Cycle 5 & 9: 720 mg/m2 IV continuous infusion on day 1
- Filgrastim (Neupogen) as follows:
- Cycle 5 & 9: 5 mcg/kg SC for at least 7 days, or until ANC ≥ 750/μl, beginning on day 2
- ANC ≥ 750/μl on or before day 7 of the cycle is not sufficient for discontinuing G-CSF
- Cycle 5 & 9: 5 mcg/kg SC for at least 7 days, or until ANC ≥ 750/μl, beginning on day 2
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
- Cycle 6, 8, 10, 12, & 14: 1800 mg/m2 IV infusion over 1 hour once on day 1 to 5
- 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
- Cycle 6, 8, 10, 12, & 14: 100 mg/m2 IV infusion over 1 to 2 hours once on days 1 to 5
Supportive medications, IE portion
- Mesna (Mesnex) as follows:
- Cycle 6, 8, 10, 12, & 14: 1080 mg/m2 IV continuous infusion on day 1
- NOTE: Protocol states that Mesna (Mesnex) should be dosed as AT LEAST 60% of Ifosfamide (Ifex) m2
- Mesna (Mesnex) continuous infusion should be started at the same time as the Ifosfamide (Ifex) and remain until at least 8 hours after the end of the Ifosfamide (Ifex) infusion
- Cycle 6, 8, 10, 12, & 14: 1080 mg/m2 IV continuous infusion on day 1
- 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
- Cycle 6, 8, 10, 12, & 14: 5 mcg/kg SC for at least 7 days, or until ANC ≥ 750/μl, beginning on day 6
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
- Cycle 7: 2 mg/m2 IV push once on day 1 (maximum dose of 2 mg)
- 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
- Cycle 7: 75 mg/m2 IV infusion over 48 hours once on day 1
- 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
- Cycle 7: 1200 mg/m2 IV over 1 hour on Days 1
Supportive therapy, VDC portion Regimen A1 (Surgery Only)
- Mesna (Mesnex) as follows:
- Cycle 7: 720 mg/m2 IV continuous infusion on day 1
- NOTE: Protocol states that Mesna (Mesnex) should be dosed as AT LEAST 60% of Cyclophosphamide (Cytoxan) m2
- Mesna (Mesnex) continuous infusion should be started at the same time as the Cyclophosphamide (Cytoxan) and remain until at least 8 hours after the end of the Cyclophosphamide (Cytoxan) infusion
- Cycle 7: 720 mg/m2 IV continuous infusion on day 1
- Filgrastim (Neupogen) as follows:
- Cycle 7: 5 mcg/kg SC for at least 7 days, or until ANC ≥ 750/μl, beginning on day 2
- ANC ≥ 750/μl on or before day 7 of the cycle is not sufficient for discontinuing G-CSF
21 day cycle
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
- Cycle 7: 2 mg/m2 IV push once on day 1 (maximum dose of 2 mg)
- 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
- Cycle 7: 1200 mg/m2 IV over 1 hour on Days 1
Supportive medications, VC portion Regimen A2 & A3 (Radiation w/ or w/o Surgery)
- Mesna (Mesnex) as follows:
- Cycle 7: 720 mg/m2 IV continuous infusion on day 1
- NOTE: Protocol states that Mesna (Mesnex) should be dosed as AT LEAST 60% of Cyclophosphamide (Cytoxan) m2
- Mesna (Mesnex) continuous infusion should be started at the same time as the Cyclophosphamide (Cytoxan) and remain until at least 8 hours after the end of the Cyclophosphamide (Cytoxan) infusion
- Cycle 7: 720 mg/m2 IV continuous infusion on day 1
- Filgrastim (Neupogen) as follows:
- Cycle 7: 5 mcg/kg SC for at least 7 days, or until ANC ≥ 750/μl, beginning on day 2
- ANC ≥ 750/μl on or before day 7 of the cycle is not sufficient for discontinuing G-CSF
21 day cycle
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
- Cycle 11: 2 mg/m2 IV push once on day 1 (maximum dose of 2 mg)
- 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
- Cycle 11: 1200 mg/m2 IV over 1 hour on Days 1
Supportive medications, VC portion Regimen A1 (Surgery Only)
- Mesna (Mesnex) as follows:
- Cycle 11: 720 mg/m2 IV continuous infusion on day 1
- NOTE: Protocol states that Mesna (Mesnex) should be dosed as AT LEAST 60% of Cyclophosphamide (Cytoxan) m2
- Mesna (Mesnex) continuous infusion should be started at the same time as the Cyclophosphamide (Cytoxan) and remain until at least 8 hours after the end of the Cyclophosphamide (Cytoxan) infusion
- Cycle 11: 720 mg/m2 IV continuous infusion on day 1
- Filgrastim (Neupogen) as follows:
- Cycle 11: 5 mcg/kg SC for at least 7 days, or until ANC ≥ 750/μl, beginning on day 2
- ANC ≥ 750/μl on or before day 7 of the cycle is not sufficient for discontinuing G-CSF
- Cycle 11: 5 mcg/kg SC for at least 7 days, or until ANC ≥ 750/μl, beginning on day 2
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
- Cycle 11: 2 mg/m2 IV push once on day 1 (maximum dose of 2 mg)
- 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
- Cycle 11: 75 mg/m2 IV infusion over 48 hours once on day 1
- 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
- Cycle 11: 1200 mg/m2 IV over 1 hour on Days 1
Supportive medications, VDC portion Regimen A2 & A3 (Radiation w/ or w/o Surgery)
- Mesna (Mesnex) as follows:
- Cycle 11: 720 mg/m2 IV continuous infusion on day 1
- NOTE: Protocol states that Mesna (Mesnex) should be dosed as AT LEAST 60% of Cyclophosphamide (Cytoxan) m2
- Mesna (Mesnex) continuous infusion should be started at the same time as the Cyclophosphamide (Cytoxan) and remain until at least 8 hours after the end of the Cyclophosphamide (Cytoxan) infusion
- Cycle 11: 720 mg/m2 IV continuous infusion on day 1
- Filgrastim (Neupogen) as follows:
- Cycle 11: 5 mcg/kg SC for at least 7 days, or until ANC ≥ 750/μl, beginning on day 2
- ANC ≥ 750/μl on or before day 7 of the cycle is not sufficient for discontinuing G-CSF
21 day cycle
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
- Cycle 13: 2 mg/m2 IV push once on day 1 (maximum dose of 2 mg)
- 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
- Cycle 13: 1200 mg/m2 IV over 1 hour on Days 1
Supportive medications, VC portion
- Mesna (Mesnex) as follows:
- Cycle 13: 720 mg/m2 IV continuous infusion on day 1
- NOTE: Protocol states that Mesna (Mesnex) should be dosed as AT LEAST 60% of Cyclophosphamide (Cytoxan) m2
- Mesna (Mesnex) continuous infusion should be started at the same time as the Cyclophosphamide (Cytoxan) and remain until at least 8 hours after the end of the Cyclophosphamide (Cytoxan) infusion
- Cycle 13: 720 mg/m2 IV continuous infusion on day 1
- Filgrastim (Neupogen) as follows:
- Cycle 13: 5 mcg/kg SC for at least 7 days, or until ANC ≥ 750/μl, beginning on day 2
- ANC ≥ 750/μl on or before day 7 of the cycle is not sufficient for discontinuing G-CSF
- Cycle 13: 5 mcg/kg SC for at least 7 days, or until ANC ≥ 750/μl, beginning on day 2
21 day cycle
References
- 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
- Cycles 1, 3, & 5: 2 mg/m2 IV push once on day 1 (maximum dose of 2 mg)
- 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
- Cycles 1, 3, & 5: 75 mg/m2 IV infusion over 48 hours once on day 1
- 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
- Cycles 1, 3, & 5: 1200 mg/m2 IV over 1 hour on Days 1
Supportive medications, VDC portion
- Mesna (Mesnex) as follows:
- Cycles 1, 3, & 5: 720 mg/m2 IV continuous infusion on day 1
- NOTE: Protocol states that Mesna (Mesnex) should be dosed as AT LEAST 60% of Cyclophosphamide (Cytoxan) m2
- Mesna (Mesnex) continuous infusion should be started at the same time as the Cyclophosphamide (Cytoxan) and remain until at least 8 hours after the end of the Cyclophosphamide (Cytoxan) infusion
- Cycles 1, 3, & 5: 720 mg/m2 IV continuous infusion on day 1
- Filgrastim (Neupogen) as follows:
- Cycles 1, 3, & 5: 5 mcg/kg SC for at least 7 days, or until ANC ≥ 750/μl, beginning on day 2
- ANC ≥ 750/μl on or before day 7 of the cycle is not sufficient for discontinuing G-CSF
- Cycles 1, 3, & 5: 5 mcg/kg SC for at least 7 days, or until ANC ≥ 750/μl, beginning on day 2
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
- Cycle 2, 4, & 6: 1800 mg/m2 IV infusion over 1 hour once on day 1 to 5
- 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
- Cycle 2, 4, & 6: 100 mg/m2 IV infusion over 1 to 2 hours once on days 1 to 5
Supportive medications, IE portion
- Mesna (Mesnex) as follows:
- Cycle 2, 4, & 6: 1080 mg/m2 IV continuous infusion on day 1
- NOTE: Protocol states that Mesna (Mesnex) should be dosed as AT LEAST 60% of Ifosfamide (Ifex) m2
- Mesna (Mesnex) continuous infusion should be started at the same time as the Ifosfamide (Ifex) and remain until at least 8 hours after the end of the Ifosfamide (Ifex) infusion
- Cycle 2, 4, & 6: 1080 mg/m2 IV continuous infusion on day 1
- 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
- Cycle 2, 4, & 6: 5 mcg/kg SC for at least 7 days, or until ANC ≥ 750/μl, beginning on day 6
14 day cycle
References
- 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 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
- Cycle 7: 2 mg/m2 IV push once on day 1 (maximum dose of 2 mg)
- 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
- Cycle 7: 75 mg/m2 IV infusion over 48 hours once on day 1
- 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
- Cycle 7: 1200 mg/m2 IV over 1 hour on Days 1
Supportive medications, VDC portion
- Mesna (Mesnex) as follows:
- Cycle 7: 720 mg/m2 IV continuous infusion on day 1
- NOTE: Protocol states that Mesna (Mesnex) should be dosed as AT LEAST 60% of Cyclophosphamide (Cytoxan) m2
- Mesna (Mesnex) continuous infusion should be started at the same time as the Cyclophosphamide (Cytoxan) and remain until at least 8 hours after the end of the Cyclophosphamide (Cytoxan) infusion
- Cycle 7: 720 mg/m2 IV continuous infusion on day 1
- Filgrastim (Neupogen) as follows:
- Cycle 7: 5 mcg/kg SC for at least 7 days, or until ANC ≥ 750/μl, beginning on day 2
- ANC ≥ 750/μl on or before day 7 of the cycle is not sufficient for discontinuing G-CSF
- Cycle 7: 5 mcg/kg SC for at least 7 days, or until ANC ≥ 750/μl, beginning on day 2
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
- Cycle 8, 10, 12, & 14: 1800 mg/m2 IV infusion over 1 hour once on day 1 to 5
- 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
- Cycle 8, 10, 12, & 14: 100 mg/m2 IV infusion over 1 to 2 hours once on days 1 to 5
Supportive medications, IE portion
- Mesna (Mesnex) as follows:
- Cycle 8, 10, 12, & 14: 1080 mg/m2 IV continuous infusion on day 1
- NOTE: Protocol states that Mesna (Mesnex) should be dosed as AT LEAST 60% of Ifosfamide (Ifex) m2
- Mesna (Mesnex) continuous infusion should be started at the same time as the Ifosfamide (Ifex) and remain until at least 8 hours after the end of the Ifosfamide (Ifex) infusion
- Cycle 8, 10, 12, & 14: 1080 mg/m2 IV continuous infusion on day 1
- 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
- Cycle 8, 10, 12, & 14: 5 mcg/kg SC for at least 7 days, or until ANC ≥ 750/μl, beginning on day 6
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
- Cycle 9: 2 mg/m2 IV push once on day 1 (maximum dose of 2 mg)
- 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
- Cycle 9: 75 mg/m2 IV infusion over 48 hours once on day 1
- 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
- Cycle 9: 1200 mg/m2 IV over 1 hour on Days 1
Supportive medications, VDC portion Regimen B1 (Surgery Only)
- Mesna (Mesnex) as follows:
- Cycle 9: 720 mg/m2 IV continuous infusion on day 1
- NOTE: Protocol states that Mesna (Mesnex) should be dosed as AT LEAST 60% of Cyclophosphamide (Cytoxan) m2
- Mesna (Mesnex) continuous infusion should be started at the same time as the Cyclophosphamide (Cytoxan) and remain until at least 8 hours after the end of the Cyclophosphamide (Cytoxan) infusion
- Cycle 9: 720 mg/m2 IV continuous infusion on day 1
- Filgrastim (Neupogen) as follows:
- Cycle 9: 5 mcg/kg SC for at least 7 days, or until ANC ≥ 750/μl, beginning on day 2
- ANC ≥ 750/μl on or before day 7 of the cycle is not sufficient for discontinuing G-CSF
- Cycle 9: 5 mcg/kg SC for at least 7 days, or until ANC ≥ 750/μl, beginning on day 2
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
- Cycle 9: 2 mg/m2 IV push once on day 1 (maximum dose of 2 mg)
- 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
- Cycle 9: 1200 mg/m2 IV over 1 hour on Days 1
Supportive medications, VC portion Regimen B2 & B3 (Radiation w/ or w/o Surgery)
- Mesna (Mesnex) as follows:
- Cycle 9: 720 mg/m2 IV continuous infusion on day 1
- NOTE: Protocol states that Mesna (Mesnex) should be dosed as AT LEAST 60% of Cyclophosphamide (Cytoxan) m2
- Mesna (Mesnex) continuous infusion should be started at the same time as the Cyclophosphamide (Cytoxan) and remain until at least 8 hours after the end of the Cyclophosphamide (Cytoxan) infusion
- Cycle 9: 720 mg/m2 IV continuous infusion on day 1
- Filgrastim (Neupogen) as follows:
- Cycle 9: 5 mcg/kg SC for at least 7 days, or until ANC ≥ 750/μl, beginning on day 2
- ANC ≥ 750/μl on or before day 7 of the cycle is not sufficient for discontinuing G-CSF
- Cycle 9: 5 mcg/kg SC for at least 7 days, or until ANC ≥ 750/μl, beginning on day 2
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
- Cycle 11: 2 mg/m2 IV push once on day 1 (maximum dose of 2 mg)
- 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
- Cycle 11: 1200 mg/m2 IV over 1 hour on Days 1
Supportive medications, VC portion
- Mesna (Mesnex) as follows:
- Cycle 11: 720 mg/m2 IV continuous infusion on day 1
- NOTE: Protocol states that Mesna (Mesnex) should be dosed as AT LEAST 60% of Cyclophosphamide (Cytoxan) m2
- Mesna (Mesnex) continuous infusion should be started at the same time as the Cyclophosphamide (Cytoxan) and remain until at least 8 hours after the end of the Cyclophosphamide (Cytoxan) infusion
- Cycle 11: 720 mg/m2 IV continuous infusion on day 1
- Filgrastim (Neupogen) as follows:
- Cycle 11: 5 mcg/kg SC for at least 7 days, or until ANC ≥ 750/μl, beginning on day 2
- ANC ≥ 750/μl on or before day 7 of the cycle is not sufficient for discontinuing G-CSF
- Cycle 11: 5 mcg/kg SC for at least 7 days, or until ANC ≥ 750/μl, beginning on day 2
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
- Cycle 13: 2 mg/m2 IV push once on day 1 (maximum dose of 2 mg)
- 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
- Cycle 13: 1200 mg/m2 IV over 1 hour on Days 1
Supportive medications, VC portion Regimen B1 (Surgery Only)
- Mesna (Mesnex) as follows:
- Cycle 13: 720 mg/m2 IV continuous infusion on day 1
- NOTE: Protocol states that Mesna (Mesnex) should be dosed as AT LEAST 60% of Cyclophosphamide (Cytoxan) m2
- Mesna (Mesnex) continuous infusion should be started at the same time as the Cyclophosphamide (Cytoxan) and remain until at least 8 hours after the end of the Cyclophosphamide (Cytoxan) infusion
- Cycle 13: 720 mg/m2 IV continuous infusion on day 1
- Filgrastim (Neupogen) as follows:
- Cycle 13: 5 mcg/kg SC for at least 7 days, or until ANC ≥ 750/μl, beginning on day 2
- ANC ≥ 750/μl on or before day 7 of the cycle is not sufficient for discontinuing G-CSF
- Cycle 13: 5 mcg/kg SC for at least 7 days, or until ANC ≥ 750/μl, beginning on day 2
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
- Cycle 13: 2 mg/m2 IV push once on day 1 (maximum dose of 2 mg)
- 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
- Cycle 13: 75 mg/m2 IV infusion over 48 hours once on day 1
- 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
- Cycle 13: 1200 mg/m2 IV over 1 hour on Days 1
Supportive medications, VDC portion Regimen B2 & B3 (Radiation w/ or w/o Surgery)
- Mesna (Mesnex) as follows:
- Cycle 13: 720 mg/m2 IV continuous infusion on day 1
- NOTE: Protocol states that Mesna (Mesnex) should be dosed as AT LEAST 60% of Cyclophosphamide (Cytoxan) m2
- Mesna (Mesnex) continuous infusion should be started at the same time as the Cyclophosphamide (Cytoxan) and remain until at least 8 hours after the end of the Cyclophosphamide (Cytoxan) infusion
- Cycle 13: 720 mg/m2 IV continuous infusion on day 1
- Filgrastim (Neupogen) as follows:
- Cycle 13: 5 mcg/kg SC for at least 7 days, or until ANC ≥ 750/μl, beginning on day 2
- ANC ≥ 750/μl on or before day 7 of the cycle is not sufficient for discontinuing G-CSF
- Cycle 13: 5 mcg/kg SC for at least 7 days, or until ANC ≥ 750/μl, beginning on day 2
14 day cycle
References
- 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