VDC-ICE treatment plan
The core treatment plan was adapted from published dosing and
administration schedules. The plan consists of eight alternating cycles
of VDC and ICE given intravenously. Cycles of VDC consist of
cyclophosphamide 1800-2100 (higher dose for MRT) mg/m2given on day 1, doxorubicin 37.5 mg/m2 given days 1
and 2 (or a single dose on day 1), and vincristine 1.5
mg/m2 given days 1, 8, and 15 (or a single dose on day
1). Cycles of ICE consist of carboplatin at a target AUC of 6 mg/ml-min
given on day 1, with ifosfamide 2000 mg/m2 and
etoposide 100 mg/m2 given days 2, 3, and 4. Mesna was
administered for bladder protection with all doses of cyclophosphamide
or ifosfamide, per institutional standards. Growth factor with
filgrastim or pegfilgrastim, and cardioprotection with dexrazoxane
(dosed at 10 times the doxorubicin dose as 375 mg/m2),
were administered per institutional standards to all patients. Cycles
were three weeks in duration, with an allowable interruption of up to
two weeks for surgical resection of the primary or residual tumor.
Radiation therapy was recommended concurrently with chemotherapy.
Modifications in chemotherapy doses or changes to the order of
chemotherapy cycles (e.g., giving consecutive ICE cycles to avoid
anthracyclines concurrently with radiation) were at the discretion of
the patient’s oncologist. Supportive care often included aggressive and
extended anti-emetic regimens and extended supplemental intravenous
fluid replacement.