Vincristine + Doxorubicin + Cyclophosphamide + Ifosfamide + Etoposide

The drug combination vincristine + doxorubicin + cyclophosphamide + ifosfamide + etoposide is commonly used in the treatment of various sarcomas, particularly Ewing sarcoma. This combination is often administered in alternating cycles, with vincristine, doxorubicin, and cyclophosphamide (VDC) alternating with ifosfamide and etoposide (IE). ## Treatment Regimen This chemotherapy combination is typically administered intravenously, often through a central line, PICC line, or portacath due to the vesicant properties of some components. The regimen is commonly referred to as VDC/IE when administered in alternating cycles. For Ewing sarcoma, the standard protocol involves interval-compressed therapy where VDC alternates with IE every 2 weeks, which has shown improved event-free survival compared to the traditional 3-week interval schedule. ## Mechanism of Action Each drug in this combination works through different mechanisms to destroy rapidly dividing cancer cells: - **Vincristine**: Inhibits microtubule formation during cell division - **Doxorubicin**: Intercalates DNA and inhibits topoisomerase II - **Cyclophosphamide**: Alkylating agent that cross-links DNA - **Ifosfamide**: Alkylating agent similar to cyclophosphamide - **Etoposide**: Topoisomerase II inhibitor that prevents DNA repair ## Clinical Applications This combination is primarily used for: - Ewing sarcoma family of tumors (bone and soft tissue) - Desmoplastic small round cell tumors - High-risk rhabdomyosarcoma (in modified regimens) ## Efficacy Studies have shown significant efficacy with this combination: - In localized Ewing sarcoma, interval-compressed VDC/IE has demonstrated 5-year event-free survival rates of approximately 64% - However, outcomes remain poor for patients with metastatic disease, with 5-year event-free survival rates around 13% ## Side Effects Common side effects include: - Febrile neutropenia (occurring after approximately 49% of cycles) - Cardiac dysfunction (both clinical and subclinical) - Bone pain (associated with G-CSF) - Anemia - Alopecia - Kidney dysfunction - Nausea and vomiting The regimen carries substantial toxicity, with reports of toxic deaths and secondary myelodysplastic syndrome in some studies. ## Administration For adult patients, studies have shown that interval-compressed therapy (cycles every 2 weeks) is feasible, with a median interval between cycles of 15 days, comparable to results in pediatric populations.

Other names

VDC/IE