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Systemic Anti-Cancer Therapy Regimen Library

Home > SAR Rhabdomyosarcoma - vinCRISTine, irinotecan, IFOSFamide, etoposide, DOXOrubicin, CYCLOPHOSPHamide and daCTINomycin [ARST0431] [high risk] > SAR - VDC + V [vinCRISTine days 1 and 8, DOXOrubicin and CYCLOPHOSPHamide] [Q2W] ARST0431 [high risk]
This regimen is a component of SAR Rhabdomyosarcoma - vinCRISTine, irinotecan, IFOSFamide, etoposide, DOXOrubicin, CYCLOPHOSPHamide and daCTINomycin [ARST0431] [high risk]

ARST0431 [high risk] - VDC + V [vinCRISTine days 1 and 8, DOXOrubicin and CYCLOPHOSPHamide] [Q2W] (SAR Rhabdomyosarcoma - vinCRISTine, irinotecan, IFOSFamide, etoposide, DOXOrubicin, CYCLOPHOSPHamide and daCTINomycin [ARST0431] [high risk])

Treatment Overview

As a 2-week cycle for cycles 3, 5, 7 and 12, or as per patient's individual treatment plan.

Growth factor support with filgrastim is used in 14-day cycles; pegFILGRASTIM is not recommended with cycles given every 14 days.


This regimen contains a medicine where one or more biosimilars may exist. Any biosimilars used have been reviewed by the regulator (Medsafe) and relevant specialists were consulted nationally. Where regulators, in consultation with relevant specialists, have agreed that there are no clinically significant differences in either safety or effectiveness between a biosimilar and originator product, these drugs may be used interchangeably.

Cycles 1 to 4 - 14 days

Cycle length:
14

filgrastim: Give filgrastim 5 micrograms/kg subcutaneously ONCE daily from Day 3 until neutrophil recovery past the nadir.

Cycle details

Cycles 1 to 4 - 14 days

Medication Dose Route Days Max Duration
olanzapine * 5 mg oral administration 1 to 4
aprepitant 125 mg oral administration 1
aprepitant 80 mg oral administration 2, 3
dexamethasone * 12 mg oral administration 1
dexamethasone * 8 mg oral administration 2, 3, 4
ondansetron 8 mg oral administration 1, 2
vinCRISTine * 1.5 mg/m² Cap dose per administration at: 2 mg intravenous 1, 8 10 minutes
DOXOrubicin * 37.5 mg/m² Once daily intravenous 1, 2 24 hours Min: 24 hours
mesna * 240 mg/m² intravenous 1 15 minutes
CYCLOPHOSPHamide * 1200 mg/m² intravenous 1 60 minutes
mesna * 240 mg/m² intravenous 1 15 minutes
mesna * 240 mg/m² intravenous 1 15 minutes
ondansetron 8 mg oral administration 1, 2
filgrastim 5 microgram/kg Once daily subcutaneous injection 3
cyclIZINE 50 mg Three times daily oral administration 1
docusate sodium + sennoside B 2 Tablet(s) oral administration 1

filgrastim: Give filgrastim 5 micrograms/kg subcutaneously ONCE daily from Day 3 until neutrophil recovery past the nadir.

Full details

Cycles 1 to 4 - 14 days

Day: 1

Medication Dose Route Max duration Details
olanzapine * 5 mg oral administration
Instructions:

ONE hour prior to chemotherapy.

  • This medicine may make you sleepy and make it dangerous to drive or operate machinery. Limit alcohol intake.
  • Some centres may choose to omit pre-chemotherapy dose or advise patient to take the night before chemotherapy if patient has to drive to appointment.
aprepitant 125 mg oral administration
Instructions:
ONE hour prior to chemotherapy.
dexamethasone * 12 mg oral administration
Instructions:

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

ONE hour prior to chemotherapy.
vinCRISTine * 1.5 mg/m² Cap dose per administration at: 2 mg intravenous 10 minutes
Instructions:
  • Diluted in a minibag.
  • FOR INTRAVENOUS USE ONLY – fatal if given by any other routes.
  • Warning vesicant—ensure vein is patent prior to administration, administer vesicant as per institutional policy and monitor for signs of extravasation throughout administration.
DOXOrubicin * 37.5 mg/m² Once daily intravenous 24 hours Min: 24 hours
Instructions:
  • Continuous infusion over 24 hours.
  • Administer daily for 2 days, total dose 75 mg/m2 over 48 hours.
  • Warning vesicant–ensure vein is patent prior to administration, administer vesicant as per institutional policy and monitor for signs of extravasation throughout administration.
mesna * 240 mg/m² intravenous 15 minutes
Instructions:

Immediately prior to CYCLOPHOSPHamide infusion over 15 minutes, or as per institutional practice.
CYCLOPHOSPHamide * 1200 mg/m² intravenous 60 minutes
Instructions:

Consider hydration with at least 2000 to 3000 ml over 24 hours as oral or IV fluid on day(s) of CYCLOPHOSPHamide and for  24 hours after or as per institutional practice.
mesna * 240 mg/m² intravenous 15 minutes
Instructions:

At 4 hours from the start of CYCLOPHOSPHamide infusion, or as per institutional practice.
mesna * 240 mg/m² intravenous 15 minutes
Instructions:

At 8 hours from the start of CYCLOPHOSPHamide infusion, or as per institutional practice.
ondansetron 8 mg oral administration
Instructions:

EIGHT hours after chemotherapy OR before bed.
cyclIZINE 50 mg Three times daily oral administration
Instructions:

When required for nausea and/or vomiting.

  • Warning: may cause drowsiness.
  • Consider starting dose at 25 mg and increasing as tolerated/required.
  • The choice of rescue antiemetic may be substituted to reflect institutional policy or individual patient characteristics.
  • Note that domperidone is not recommended in combination with olanzapine and ondansetron due to potential risk of QT prolongation.
docusate sodium + sennoside B 2 Tablet(s) oral administration
Instructions:

At night when required for constipation.

Each tablet contains docusate sodium 50 mg + sennoside B 8 mg.

Day: 2

Medication Dose Route Max duration Details
olanzapine * 5 mg oral administration
Instructions:

ONCE daily.

This medicine may make you sleepy and make it dangerous to drive or operate machinery. Limit alcohol intake.
aprepitant 80 mg oral administration
Instructions:
ONCE daily in the morning.
dexamethasone * 8 mg oral administration
Instructions:

ONCE daily in the morning with food.
ondansetron 8 mg oral administration
Instructions:

ONE hour prior to chemotherapy.
DOXOrubicin * 37.5 mg/m² Once daily intravenous 24 hours Min: 24 hours
Instructions:
  • Continuous infusion over 24 hours.
  • Administer daily for 2 days, total dose 75 mg/m2 over 48 hours.
  • Warning vesicant–ensure vein is patent prior to administration, administer vesicant as per institutional policy and monitor for signs of extravasation throughout administration.
ondansetron 8 mg oral administration
Instructions:

EIGHT hours after chemotherapy OR before bed.

Day: 3

Medication Dose Route Max duration Details
olanzapine * 5 mg oral administration
Instructions:

ONCE daily.

This medicine may make you sleepy and make it dangerous to drive or operate machinery. Limit alcohol intake.
aprepitant 80 mg oral administration
Instructions:
ONCE daily in the morning.
dexamethasone * 8 mg oral administration
Instructions:

ONCE daily in the morning with food.

Dose and duration may be individualised at clinician’s discretion.
filgrastim 5 microgram/kg Once daily subcutaneous injection
Instructions:

Give ONCE daily from Day 3 until neutrophil recovery past the nadir.

Round dose to nearest prefilled syringe dose of 300 micrograms or 480 micrograms.

Day: 4

Medication Dose Route Max duration Details
olanzapine * 5 mg oral administration
Instructions:

ONCE daily.

This medicine may make you sleepy and make it dangerous to drive or operate machinery. Limit alcohol intake.
dexamethasone * 8 mg oral administration
Instructions:

ONCE daily in the morning with food.

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

Day: 8

Medication Dose Route Max duration Details
vinCRISTine * 1.5 mg/m² Cap dose per administration at: 2 mg intravenous 10 minutes
Instructions:
  • Diluted in a minibag.
  • FOR INTRAVENOUS USE ONLY – fatal if given by any other routes.
  • Warning vesicant—ensure vein is patent prior to administration, administer vesicant as per institutional policy and monitor for signs of extravasation throughout administration.

Supportive Care Factors

Factor Value
Constipation risk: laxatives are usually prescribed
Emetogenicity: Variable
Growth factor support: Recommended for primary prophylaxis
Hydration: Hydration may be considered
Mesna uroprotection: Routine mesna uroprotection recommended

Emetogenicity: HIGH day 1 and 2; MINIMAL day 8.

References

Tabernero J, Vyas M, Giuliani R, Arnold D, Cardoso F, Casali PG, Cervantes A, Eggermont AMM, Eniu A, Jassem J, Pentheroudakis G, Peters S, Rauh S, Zielinski CC, Stahel RA, Voest E, Douillard JY, McGregor K, Ciardiello F. Biosimilars: a position paper of the European Society for Medical Oncology, with particular reference to oncology prescribers. ESMO Open. 2017 Jan 16;1(6):e000142., PMID: 28848668

Lyman GH, Balaban E, Diaz M, Ferris A, Tsao A, Voest E, Zon R, Francisco M, Green S, Sherwood S, Harvey RD, Schilsky RL. American Society of Clinical Oncology Statement: Biosimilars in Oncology. J Clin Oncol. 2018 Apr 20;36(12):1260-1265. doi: 10.1200/JCO.2017.77.4893. Epub 2018 Feb 14., PMID: 29443651

* 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.