Sarcoma - Soft Tissue
Regimen is considered appropriate as part of the standard care of patients; meaningfully improves outcomes (survival, quality of life), tolerability or costs compared to alternatives (recommended by the Disease Site Team and national consensus body e.g. pan-Canadian Oncology Drug Review, pCODR). Recommendation is based on an appropriately conducted phase III clinical trial relevant to the Canadian context OR (where phase III trials are not feasible) an appropriately sized phase II trial. Regimens where one or more drugs are not approved by Health Canada for any indication will be identified under Rationale and Use.
This Regimen Abstract is an abbreviated version of a Regimen Monograph and contains only top level information on usage, dosing, schedule, cycle length and special notes (if available). Information in regimen abstracts is accurate to the extent of the ST-QBP regimen master listings, and has not undergone the full review process of a regimen monograph. Full regimen monographs will be published for each ST-QBP regimen as they are developed.
Please report ETOPIFOS while on the IE portion and VAC while on the VAC portion. Refer to ETOPIFOS and VAC regimen monographs.
|etoposide||100 mg /m²||IV||Days 1 to 5|
|ifosfamide||1800 mg /m²||IV||Days 1 to 5|
Various dosing schedules have been used. The following is an example (from ASCO guideline, Hensley 2009):
|vinCRIStine||1.5 mg /m²||IV (maximum 2 mg)||Day 1|
|75 mg /m²||IV||Day 1|
|1200 mg /m²||IV||Day 1|
1Doxorubicin is omitted during radiation therapy. Some studies split the dose of doxorubicin over 2 days. Give for a maximum of 5-6 cycles and then VC thereafter.
2 Prophylactic diuresis to reduce the incidence of cystitis is recommended. Consider usage of Mesna (refer to local protocols), especially for younger patients or those with risk factors (e.g. previous radiation to the pelvic area).
Standard schedule: ETOPIFOS alternating with VAC*/VC for a total of 14 cycles given every 3 weeks (7 of each) in the absence of progression or unacceptable toxicity.
Intensified schedule†(for Ewing's sarcoma): ETOPIFOS alternating with VAC*/VC for a total of 14 cycles given every 2 weeks (7 of each) in the absence of progression or unacceptable toxicity. G-CSF prophylaxis is recommended with this regimen.
*VAC for a maximum of 5-6 cycles then VC
† Note that only patients less than 50 years old were included in the clinical trial by Womer et al.
Other Supportive Care:
Also refer to CCO Antiemetic Recommendations.
Arndt CAS, Nascimento AG, Schroeder G, et al. Treatment of intermediate rish rhabdomyosarcoma and undifferentiated sarcoma with alternating cycles of vincristine/ doxorubicin/ cyclophosphamide and etoposide/ifosfamide. European Journal of Cancer 1998; 34(8) : 1224-1229.
Granowetter L, Womer R, Devidas M, et al. Dose-intensified compared with standard chemotherapy for nonmetastatic Ewing sarcoma family of tumors: a Children's Oncology Group Study. J Clin Oncol 2009;27(15):2536-41.
Grier HE, Krailo MD, Tarbell NJ, et al. Addition of ifosfamide and etoposide to standard chemotherapy for Ewing's sarcoma and primitive neuroectodermal tumor of bone. N Engl J Med. 2003;348(8):694-701.
Paulussen M, Craft AW, Lewis I, et al. Results of the EICESS-92 Study: two randomized trials of Ewing's sarcoma treatment--cyclophosphamide compared with ifosfamide in standard-risk patients and assessment of benefit of etoposide added to standard treatment in high-risk patients. J Clin Oncol. 2008;26(27):4385-93.
Wexler LH, DeLaney TF, Tsokos M, et al. Ifosfamide and etoposide plus vincristine, doxorubicin, and cyclophosphamid for newly diagnosed Ewing’s sarcoma family for tumors. Cancer 1996 (Aug 15th) ; 78 (4):901- 911.
Womer RB, West DC, Krailo MD, Dickman PS, Pawel BR, Grier HE, Marcus K, Sailer S, Healey JH, Dormans JP, 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):4148-54.
June 2019 Updated emetic risk category
Sarcomas are rare tumours and as such benefit from referral to specialized centres where there will be access to multidisciplinary expertise including good radiology, orthopedic and thoracic surgery, medical oncology, radiation oncology, pathology, and other supportive care disciplines.
A Regimen Abstract is an abbreviated version of a Regimen Monograph and contains only top level information on usage, dosing, schedule, cycle length and special notes (if available). It is intended for healthcare providers and is to be used for informational purposes only. It is not intended to constitute or be a substitute for medical advice, and all uses of the Regimen Abstract are subject to clinical judgment. Such information is provided on an “as-is” basis, without any representation, warranty, or condition, whether express, or implied, statutory or otherwise, as to the information’s quality, accuracy, currency, completeness, or reliability, and Cancer Care Ontario disclaims all liability for the use of this information, and for any claims, actions, demands or suits that arise from such use.
Information in regimen abstracts is accurate to the extent of the ST-QBP regimen master listings, and has not undergone the full review process of a regimen monograph. Full regimen monographs will be published for each ST-QBP regimen as they are developed.
Refer to the New Drug Funding Program or Ontario Public Drug Programs websites for the most up-to-date public funding information.
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