{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,26]],"date-time":"2026-08-26T16:17:41Z","timestamp":1787761061410,"version":"build-2784847793"},"reference-count":17,"publisher":"Wiley","issue":"9","license":[{"start":{"date-parts":[[2026,7,29]],"date-time":"2026-07-29T00:00:00Z","timestamp":1785283200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2026,7,29]],"date-time":"2026-07-29T00:00:00Z","timestamp":1785283200000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Pediatric Blood &amp; Cancer"],"published-print":{"date-parts":[[2026,9]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>Rhabdomyosarcoma is a highly chemosensitive tumor; however, high\u2010risk and metastatic cases require more effective systemic treatments. This study evaluates the feasibility and efficacy of the \u201cVIVA\u201d regimen (vinorelbine\u2013ifosfamide\u2013vincristine\u2013actinomycin D), which incorporates weekly vinorelbine into the induction phase of standard therapy.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      Between 2020 and 2025, 45 patients (median age 14 years) with high\u2010risk or metastatic rhabdomyosarcoma were treated at the Pediatric Unit of the Istituto Nazionale Tumori in Milan. The VIVA regimen added intravenous vinorelbine (25\u00a0mg\/m\n                      <jats:sup>2<\/jats:sup>\n                      ) on Days 8 and 15 of the standard 3\u2010week IVA cycle. Treatment included nine induction cycles followed by 6\u201312 months of maintenance therapy (vinorelbine and oral cyclophosphamide), alongside multidisciplinary local control.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Forty patients (89%) completed the planned nine VIVA cycles; five discontinued early due to disease progression. Among 41 evaluable patients, the overall response rate after three cycles was 95%. The estimated 3\u2010year event\u2010free survival (EFS) and overall survival (OS) rates were 68.0% and 78.6%, respectively. Myelotoxicity was the main side effect: grade \u2265 3 neutropenia, thrombocytopenia, and anemia occurred in 70%, 7%, and 21% of cycles, respectively. Granulocyte\u2010colony\u2010stimulating factor (G\u2010CSF) was administered in 51% of cycles. Overall, 30% of the cycles required either a reduction or the omission of vinorelbine administration. Notably, 68% of patients required either no modifications (24%) or modifications in fewer than 25% of doses (44%).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Integrating vinorelbine into the intensive induction phase proved feasible with an acceptable toxicity profile and high response rates. Further investigations are needed to define the long\u2010term efficacy of this promising intensive regimen.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/1545-5017.70490","type":"journal-article","created":{"date-parts":[[2026,7,30]],"date-time":"2026-07-30T02:56:14Z","timestamp":1785380174000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["The VIVA Regimen (Vinorelbine, Ifosfamide, Vincristine, and Actinomycin\u2010D) for High\u2010Risk Rhabdomyosarcoma: Feasibility and Outcomes From a Single\u2010Institution Study"],"prefix":"10.1002","volume":"73","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-4724-0517","authenticated-orcid":false,"given":"Andrea","family":"Ferrari","sequence":"first","affiliation":[{"name":"Pediatric Oncology Unit Fondazione IRCCS Istituto Nazionale dei Tumori  Milan Italy"},{"name":"Department of Oncology and Hemato\u2010oncology University of Milan  Milan 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