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Systemic Anti-Cancer Therapy Regimen Library

Home > SAR Ewing sarcoma Relapsed - irinotecan and temozolomide

SAR Ewing sarcoma Relapsed - irinotecan and temozolomide

Treatment Overview

Cycles 1 to 6 - 21 days

Cycle length:
21

Cycle details

Cycles 1 to 6 - 21 days

Medication Dose Route Days Max Duration
dexamethasone * 8 mg oral administration 1 to 7
ondansetron 8 mg oral administration 1 to 5
temozolomide * 100 mg/m² Once daily oral administration 1 to 5
irinotecan * 50 mg/m² Once daily intravenous 1 to 5 60 minutes
atropine sulfate * 600 microgram intravenous 1 to 5 2 minutes
ondansetron 8 mg oral administration 1 to 5
domperidone 10 mg Three times daily oral administration 1
loperamide 2 mg oral administration 1

Full details

Cycles 1 to 6 - 21 days

Day: 1

Medication Dose Route Max duration Details
dexamethasone * 8 mg oral administration
Instructions:

ONE hour prior to chemotherapy with food.
ondansetron 8 mg oral administration
Instructions:

ONE hour prior to chemotherapy.
temozolomide * 100 mg/m² Once daily oral administration
Instructions:

Take ONE hour prior to irinotecan, on an empty stomach - one hour before OR two hours after food.

This medicine may make you sleepy and make it dangerous to drive or operate machinery. Limit alcohol intake.
irinotecan * 50 mg/m² Once daily intravenous 60 minutes
atropine sulfate * 600 microgram intravenous 2 minutes
Instructions:

Only if required for acute diarrhoea or cholinergic symptoms.

  • Alternatively, dose may be administered subcutaneously.
  • 600 microgram = 0.6 mg.
  • Some centres may wish to give a reduced dose of 300 microgram (= 0.3 mg) in line with institutional policy.
  • Dose may be repeated up to a maximum dose of 1200 microgram (= 1.2 mg).
ondansetron 8 mg oral administration
Instructions:

EIGHT hours after chemotherapy OR before bed.
domperidone 10 mg Three times daily oral administration
Instructions:

When required for nausea and/or vomiting.

The choice of rescue antiemetic may be substituted to reflect institutional policy or individual patient characteristics.
loperamide 2 mg oral administration
Instructions:
Take TWO capsules (=4 mg) at onset of loose bowel motions and a further ONE capsule (=2 mg) for every loose bowel motion (maximum of EIGHT capsules in 24 hours), or use as directed by oncologist or haematologist.

Day: 2

Medication Dose Route Max duration Details
dexamethasone * 8 mg oral administration
Instructions:

ONCE daily in the morning with food.

Dose and duration may be individualised at clinician’s discretion.
ondansetron 8 mg oral administration
Instructions:

ONE hour prior to chemotherapy.
temozolomide * 100 mg/m² Once daily oral administration
Instructions:

Take ONE hour prior to irinotecan, on an empty stomach - one hour before OR two hours after food.

This medicine may make you sleepy and make it dangerous to drive or operate machinery. Limit alcohol intake.
irinotecan * 50 mg/m² Once daily intravenous 60 minutes
atropine sulfate * 600 microgram intravenous 2 minutes
Instructions:

Only if required for acute diarrhoea or cholinergic symptoms.

  • Alternatively, dose may be administered subcutaneously.
  • 600 microgram = 0.6 mg.
  • Some centres may wish to give a reduced dose of 300 microgram (= 0.3 mg) in line with institutional policy.
  • Dose may be repeated up to a maximum dose of 1200 microgram (= 1.2 mg).
ondansetron 8 mg oral administration
Instructions:

EIGHT hours after chemotherapy OR before bed.

Day: 3

Medication Dose Route Max duration Details
dexamethasone * 8 mg oral administration
Instructions:

ONCE daily in the morning with food.

Dose and duration may be individualised at clinician’s discretion.
ondansetron 8 mg oral administration
Instructions:

ONE hour prior to chemotherapy.
temozolomide * 100 mg/m² Once daily oral administration
Instructions:

Take ONE hour prior to irinotecan, on an empty stomach - one hour before OR two hours after food.

This medicine may make you sleepy and make it dangerous to drive or operate machinery. Limit alcohol intake.
irinotecan * 50 mg/m² Once daily intravenous 60 minutes
atropine sulfate * 600 microgram intravenous 2 minutes
Instructions:

Only if required for acute diarrhoea or cholinergic symptoms.

  • Alternatively, dose may be administered subcutaneously.
  • 600 microgram = 0.6 mg.
  • Some centres may wish to give a reduced dose of 300 microgram (= 0.3 mg) in line with institutional policy.
  • Dose may be repeated up to a maximum dose of 1200 microgram (= 1.2 mg).
ondansetron 8 mg oral administration
Instructions:

EIGHT hours after chemotherapy OR before bed.

Day: 4

Medication Dose Route Max duration Details
dexamethasone * 8 mg oral administration
Instructions:

ONCE daily in the morning with food.

Dose and duration may be individualised at clinician’s discretion.
ondansetron 8 mg oral administration
Instructions:

ONE hour prior to chemotherapy.
temozolomide * 100 mg/m² Once daily oral administration
Instructions:

Take ONE hour prior to irinotecan, on an empty stomach - one hour before OR two hours after food.

This medicine may make you sleepy and make it dangerous to drive or operate machinery. Limit alcohol intake.
irinotecan * 50 mg/m² Once daily intravenous 60 minutes
atropine sulfate * 600 microgram intravenous 2 minutes
Instructions:

Only if required for acute diarrhoea or cholinergic symptoms.

  • Alternatively, dose may be administered subcutaneously.
  • 600 microgram = 0.6 mg.
  • Some centres may wish to give a reduced dose of 300 microgram (= 0.3 mg) in line with institutional policy.
  • Dose may be repeated up to a maximum dose of 1200 microgram (= 1.2 mg).
ondansetron 8 mg oral administration
Instructions:

EIGHT hours after chemotherapy OR before bed.

Day: 5

Medication Dose Route Max duration Details
dexamethasone * 8 mg oral administration
Instructions:

ONCE daily in the morning with food.

Dose and duration may be individualised at clinician’s discretion.
ondansetron 8 mg oral administration
Instructions:

ONE hour prior to chemotherapy.
temozolomide * 100 mg/m² Once daily oral administration
Instructions:

Take ONE hour prior to irinotecan, on an empty stomach - one hour before OR two hours after food.

This medicine may make you sleepy and make it dangerous to drive or operate machinery. Limit alcohol intake.
irinotecan * 50 mg/m² Once daily intravenous 60 minutes
atropine sulfate * 600 microgram intravenous 2 minutes
Instructions:

Only if required for acute diarrhoea or cholinergic symptoms.

  • Alternatively, dose may be administered subcutaneously.
  • 600 microgram = 0.6 mg.
  • Some centres may wish to give a reduced dose of 300 microgram (= 0.3 mg) in line with institutional policy.
  • Dose may be repeated up to a maximum dose of 1200 microgram (= 1.2 mg).
ondansetron 8 mg oral administration
Instructions:

EIGHT hours after chemotherapy OR before bed.

Day: 6

Medication Dose Route Max duration Details
dexamethasone * 8 mg oral administration
Instructions:

ONCE daily in the morning with food.

Dose and duration may be individualised at clinician’s discretion.

Day: 7

Medication Dose Route Max duration Details
dexamethasone * 8 mg oral administration
Instructions:

ONCE daily in the morning with food.

Dose and duration may be individualised at clinician’s discretion.

Supportive Care Factors

Factor Value
Diarrhoea risk: Anti-diarrhoeals are usually prescribed with this treatment
Emetogenicity: Medium
Pneumocystis jirovecii pneumonia (PJP) prophylaxis: Routine antibiotic prophylaxis may be considered

References

Raciborska, A., K. Bilska, K. Drabko, et al. 2013. "Vincristine, irinotecan, and temozolomide in patients with relapsed and refractory Ewing sarcoma." Pediatr Blood Cancer 60(10):1621-1625., PMID: 23776128

Wagner, L. M., N. McAllister, R. E. Goldsby, et al. 2007. "Temozolomide and intravenous irinotecan for treatment of advanced Ewing sarcoma." Pediatr Blood Cancer 48(2):132-13., PMID: 16317751

Casey, D. A., L. H. Wexler, M. S. Merchant, et al. 2009. "Irinotecan and temozolomide for Ewing sarcoma: the Memorial Sloan-Kettering experience." Pediatr Blood Cancer 53(6):1029-1034., PMID: 19637327

Wagner, L., B. Turpin, R. Nagarajan, et al. 2013. "Pilot study of vincristine, oral irinotecan, and temozolomide (VOIT regimen) combined with bevacizumab in pediatric patients with recurrent solid tumors or brain tumors." Pediatr Blood Cancer 60(9):1447-1451., PMID: 23630159

Blanchette, P., A. Lo., P. Ng et al. 2015. "Irinotecan and temozolomide in adults with recurrent sarcoma." Journal of Solid Tumours 5 (2); 105-111.

Wagner, L. M., K. R. Crews, L. C. Iacono, et al. 2004. "Phase I trial of temozolomide and protracted irinotecan in pediatric patients with refractory solid tumors." Clin Cancer Res 10(3):840-848., PMID: 14871959

McNall-Knapp, R. Y., C. N. Williams, E. N. Reeves, et al. 2010. "Extended phase I evaluation of vincristine, irinotecan, temozolomide, and antibiotic in children with refractory solid tumors." Pediatr Blood Cancer 54(7):909-915., PMID: 20405511

* The medicines, doses, combinations, and schedule in this treatment regimen have been carefully reviewed against international best practice guidelines by specialists in medical oncology around New Zealand and this advice has been accepted for publication by Te Aho o Te Kahu (the Cancer Control Agency). Sometimes medicines that are used in routine clinical practice have not been through a formal review process by the NZ Medicines Regulator Medsafe and are therefore considered unapproved or off-label. These medicines are legally able to be prescribed through sections 25 and 29 of the Medicines Act and by obtaining informed consent from patients. All treatment regimens listed on this website have been through robust peer review and are considered an accepted standard of care, whether prescribed through sections 25 or 29 or carrying formal Medsafe Approval.

s29: This symbol indicates that some formulations of the associated medicine are legally only able to be prescribed under section 29 of the Medicines Act. You can see which formulations are section 29 by hovering over the s29 symbol. You can access full medication details from the New Zealand Formulary by clicking on the medication name. Each clinician retains full responsibility for ensuring they have complied with all relevant obligations and requirements of section 29 including obtaining informed patient consent prior to prescribing the applicable medicine.