Chemotherapy Protocols for Medulloblastomas in Children

Standard-Risk Medulloblastoma

Cisplatin, lomustine, and vincristine regimen A (8 x 42 day cycles) (37)

• Day 0 of cycle: Lomustine, 75 mg/m2 PO
• Day 1 of cycle: Cisplatin, 75 mg/m2 IV
• Days 1, 7, 14 of cycle: Vincristine, 1.5 mg/m2 (maximum, 2 mg) IV

Cisplatin, cyclophosphamide, and vincristine regimen B (8 x 42 day cycles) (37)

• Day 1 of cycle: Cisplatin, 75 mg/m2 IV
• Days 1, 7, 14 of cycle: Vincristine, 1.5 mg/m2 (maximum, 2 mg) IV
• Days 21, 22 of cycle: Cyclophosphamide, 1000 mg/m2 IV

Topotecan during radiation, followed by four cycles of dose-intense chemotherapy for standard-risk or high-risk medulloblastomas (24. 41)

• Day -4: Cisplatin, 75 mg/m2; vincristine 1.5 mg/m2 (maximum, 2 mg) IV
• Day -3, Day -2: Cyclophosphamide, 2 g/ m2 IV, mesna IV by continuous infusion
• Day 0: Infusion of peripheral blood stem cells or bone marrow
• Day +1: G-CSF, 5 µg/kg/day SC/IV until ANC[2]>2000 / µl for 2 consecutive days after nadir
• Day +6: Vincristine, 1.5 mg/m2 (maximum, 2 mg) IV

High-Risk Medulloblastoma

Carboplatin and vincristine during radiation, followed by maintenance: cisplatin, lomustine, vincristine, and cyclophosphamide for high-risk medulloblastoma (26)

• 2 doses of carboplatin before radiation: The recommended phase 2 dose of carboplatin during radiation was 35 mg/m2 IV daily 1–4 hours before radiation, to a maximum total of 30 doses.
• Vincristine during radiation: Vincristine, 1.5 mg/m2 (maximum, 2 mg) IV weekly was given during radiation for 6 weeks.
• Maintenance: 6 cycles of cisplatin, cyclophosphamide, vincristine, every 28 days as long as counts have recovered. Cisplatin, 75 mg/ m2 IV, on day 1 is administered over 6 hours with normal saline and mannitol (7.5 g/l) at a rate of 125 ml/m2/hour. Vincristine, 1.5 mg/m2 (maximum, 2 mg), is given IV on days 1 and 8. Cyclophosphamide, 1,000 mg/m2 IV, is given over 1 hour on days 2 and 3. On the first day of administration, cyclophosphamide should be given at least 24 hours after cisplatin. Mesna, 360 mg/m2, is given IV with cyclophosphamide infusion and 3 and 6 hours after cyclophosphamide. G-CSF, 5 µg/kg/day, is given subcutaneously or IV once daily beginning 24 hours after the last dose of cyclophosphamide and continuing for at least 10 days. It is continued until post-nadir ANC > 1500/µl or a minimum of 24 hours before the next chemotherapy cycle if counts have recovered from their nadir, whichever occurs first.

Topotecan during radiation, followed by four cycles of dose-intense chemotherapy for standard-risk or high-risk medulloblastomas (24, 41)

Median cycle duration was 28 days. Each cycle consisted of the following:

• Day -4: Cisplatin, 75 mg/m2; vincristine, 1.5 mg/m2 (maximum, 2 mg) IV
• Day -3, Day -2: Cyclophosphamide, 2g/m2 IV; mesna IV by continuous infusion
• Day 0: Infusion of peripheral blood stem cells or bone marrow
• Day +1: G-CSF, 5 µg/kg/day SC/IV until ANC>2000 / µl for 2 consecutive days after nadir
• Day +6: Vincristine, 1.5 mg/m2 (maximum, 2 mg) IV