Ewing sarcoma
Prepared with OnCo (onco.cc/prep/ewing-sarcoma/). Orientation, not medical advice; your team knows your case.
My details
What I know, what is unclear, changes to discuss
Saved in this browserMy questions
17 on the sheet- 1.What is my exact diagnosis, stage, and grade, and which tests established them?
- 2.Which biomarkers have been tested on my tumour (for example EWSR1-FLI1 / EWSR1-ERG fusion, CD99 membranous staining, NKX2-2, Metastatic status, Histologic response to induction, STAG2 loss, TP53 mutation, CDKN2A deletion), and what were the results?
- 3.Which subtype is my cancer, and does that change the recommended treatment?
- 4.Is germline (inherited) genetic testing recommended for me or my family?
- 5.For my situation (localised), which of the standard options do you recommend and why?
- 6.Am I a candidate for Vincristine, Doxorubicin, Cyclophosphamide or related drugs, and what side effects should I expect?
- 7.For my situation (metastatic (lung only)), which of the standard options do you recommend and why?
- 8.Am I a candidate for Vincristine, Doxorubicin, Cyclophosphamide or related drugs, and what side effects should I expect?
- 9.For my situation (metastatic (bone/marrow)), which of the standard options do you recommend and why?
- 10.Am I a candidate for Vincristine, Doxorubicin, Cyclophosphamide, and what side effects should I expect?
- 11.For my situation (relapsed), which of the standard options do you recommend and why?
- 12.Am I a candidate for Ifosfamide, Irinotecan (and liposomal irinotecan), Temozolomide or related drugs, and what side effects should I expect?
- 13.Are there clinical trials I could join, for example of Lurbinectedin, Ifosfamide, CAR-T cell therapy, KC1036?
- 14.Would a second opinion at a high-volume centre change anything, and can you help arrange it?
- 15.What supportive care (symptom control, nutrition, exercise, mental health, financial help) is available from the start?
- 16.I read that “Metastatic-to-bone and relapsed disease: survival under 20-30%”. How does that affect my plan?
- 17.I read that “EWSR1-FLI1 remains undrugged after 30 years”. How does that affect my plan?
The words I may hear
- Gene fusion: A gene fusion is two genes broken and joined together, creating a hybrid protein that can drive cancer.
- Adolescent and young adult (AYA) oncology: Cancer in people aged 15-39, about 90,000 US cases a year, with a distinct mix of cancers, slower survival improvement than children or older adults, and specific needs: fertility, education and work, psychosocial support and trial access.
Tests and results to bring
Biomarker results to ask for: EWSR1-FLI1 / EWSR1-ERG fusion (FISH, RT-PCR, RNA-seq), CD99 membranous staining, NKX2-2, Metastatic status (lung vs bone/marrow), Histologic response to induction, STAG2 loss, TP53 mutation, CDKN2A deletion (poor prognosis), ctDNA fusion detection (emerging).
Scans and tests linked to this cancer: Methylation classifier for sarcomas.
Bring copies of scan reports, pathology and blood results, and a list of every medicine and supplement.
The treatments I may be offered
- Localised: Interval-compressed VDC/IE ×14 cycles (AEWS0031 / Euro Ewing 2012) with surgery ± radiotherapy (or definitive RT 55.8 Gy) after 6 induction cycles. (Vincristine, Doxorubicin, Cyclophosphamide, Ifosfamide, Etoposide, IMRT / IGRT (modern external beam), Limb-salvage surgery and endoprosthetic reconstruction)
- Metastatic (lung only): Same chemotherapy plus whole-lung irradiation; busulfan-melphalan high-dose therapy in selected patients (Euro-EWING 99 R2pulm equivocal). (Vincristine, Doxorubicin, Cyclophosphamide, Ifosfamide, Etoposide, Autologous stem cell transplant (high-dose therapy))
- Metastatic (bone/marrow): Chemotherapy with palliative-intent local therapy; survival <20%; trials strongly preferred. (Vincristine, Doxorubicin, Cyclophosphamide)
- Relapsed: High-dose ifosfamide (rEECur), irinotecan-temozolomide, topotecan-cyclophosphamide, gemcitabine-docetaxel; local therapy; trials. (Ifosfamide, Irinotecan (and liposomal irinotecan), Temozolomide, Topotecan, Cyclophosphamide)
From the standard of care recorded for this cancer; which apply depends on your stage and biomarkers. Ask which the team recommends and why.