Cancers & treatments·Regimen libraryCurative

VAC (vincristine, dactinomycin, cyclophosphamide)

Checked 2026-09-09

Backbone chemotherapy for childhood rhabdomyosarcoma in the Intergroup and Children's Oncology Group trials, with surgery and radiotherapy

Also called VAC.

One cycle

every 21 days × 14 · about 42 weeks in total

21-day cycle × 14 (about 42 weeks) in IRS-IV (about 42 weeks)Intravenous

Components

Drug	Dose	Route	Days
Vincristine Vinca alkaloid (microtubule inhibitor)	1.5 mg/m² (maximum 2 mg)	IV	D1, 8, 15
Dactinomycin Actinomycin antibiotic (transcription inhibitor)	0.045 mg/kg (maximum 2.5 mg)	IV	D1
Cyclophosphamide Alkylating agent (oxazaphosphorine prodrug)	2.2 g/m² with mesna	IV	D1

Cycles

14 (about 42 weeks) in IRS-IV

21-day cycle

Emetogenicity

High (>90%)

G-CSF

Recommended

Notes

Later COG trials reduced the cyclophosphamide dose (1.2 g/m²) and added irinotecan (VAC/VI) for intermediate-risk disease.
Radiotherapy is given to the primary site for all but completely resected embryonal tumours.

Used in

Rhabdomyosarcoma

Products

VincristineDactinomycin (actinomycin D)Cyclophosphamide

Source

Crist (IRS-IV), JCO 2001: VAC versus VAI versus VIE in non-metastatic rhabdomyosarcoma

Reference doses for a typical adult from the cited protocol or label. Doses are adjusted for renal and hepatic function, age, performance status and prior toxicity, and institutional protocols vary. Verify against the current label and your local protocol before treating. Not medical advice.

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