VAC/IE

Say it: VACK eye-EE

Vincristine, doxorubicin and cyclophosphamide, alternating with ifosfamide and etoposide

VAC/IE is an intense chemotherapy plan for Ewing sarcoma that switches back and forth between two medicine combinations every 2 to 3 weeks.

Also called: VAC IE, VDC/IE, VDC-IE, VAC-IE, VDC IE, interval compressed chemotherapy

What it is

Ewing sarcoma can spread through the blood even when it looks like it is in one place, so strong chemotherapy is given to the whole body. Using two combinations in turn hits the cancer cells in different ways. Chemotherapy is given before and after surgery or radiation to the main tumor. The goal is cure.

Often used for

• Ewing sarcoma
• other small round cell sarcomas
• some rhabdomyosarcomas and other sarcomas in young people

Every 2 weeks (interval compressed)

For many patients, cycles are given every 2 weeks with a white blood cell booster in between. This has been shown to work better than every 3 weeks in younger patients.

Dactinomycin swap (VC + dactinomycin)

After a set total amount of doxorubicin, dactinomycin replaces doxorubicin in the VAC cycles to protect the heart.

Rhabdomyosarcoma VAC

In rhabdomyosarcoma, VAC often means vincristine, actinomycin (dactinomycin) and cyclophosphamide, a different plan from this one.

The medicines in this plan

Vincristine

Chemotherapy that stops cells from dividing. Given through a vein on day 1 of VAC cycles.

Doxorubicin

Anthracycline chemotherapy given through a vein in VAC cycles, often over 1 to 2 days. It is swapped for dactinomycin later in treatment to protect the heart.

Cyclophosphamide

Chemotherapy that damages cancer cell DNA. Given through a vein on day 1 of VAC cycles.

Ifosfamide

Chemotherapy related to cyclophosphamide. Given through a vein on days 1 to 5 of IE cycles.

Etoposide

Chemotherapy that stops cancer cells from copying DNA. Given through a vein on days 1 to 5 of IE cycles.

Mesna

Protects the bladder from ifosfamide and cyclophosphamide. Given through a vein with them.

How you get it

VAC and IE cycles alternate, starting a new cycle every 2 to 3 weeks. VAC usually takes 1 to 2 days and IE takes 5 days; many people stay in the hospital for cycles, especially IE. Most people get about 14 cycles in total, with surgery or radiation to the main tumor after the first 6 or so. The whole plan often takes 7 to 12 months. A port or central line is placed. Your schedule may be different.

A typical cycle

Weeks 1 to 12

First cycles, alternating VAC and IE, to shrink the tumor. A white blood cell booster is given after each cycle.

VAC cycle

Vincristine, doxorubicin and cyclophosphamide with mesna and IV fluids over 1 to 2 days.

IE cycle

Ifosfamide with mesna and etoposide each day for 5 days, with IV fluids.

About week 12

Scans, then surgery and/or radiation to the main tumor (local control).

After local control

More alternating VAC and IE cycles to finish the plan, then scans and follow up.

Common side effects and what helps

• Very low blood counts after each cycle. Many people need blood or platelet transfusions.
• Infection risk, which is high. Wash hands often and avoid sick people.
• Nausea and vomiting. Take your anti-nausea medicines on schedule.
• Hair loss. It grows back after treatment.
• Mouth sores. Brush gently, rinse often and ask about pain medicine for the mouth.
• Constipation and jaw or nerve pain from vincristine. Use a daily stool softener if your team advises.
• Tiredness and weight loss. Eat small, frequent meals and ask to see a dietitian.
• Confusion or sleepiness from ifosfamide, usually short lived.
• Kidney strain and low blood salts. Your team checks blood tests and gives replacements.

Call your care team right away if you have

• A fever of 100.4 degrees Fahrenheit (38 degrees Celsius) or higher, or chills
• Blood in the urine or pain when urinating
• Confusion, extreme sleepiness, or a seizure
• Bleeding, many new bruises, or tiny red spots on the skin
• Redness, swelling or drainage at the port or line
• No bowel movement for 3 days or bad belly pain
• Vomiting or you cannot keep fluids down
• Shortness of breath, chest pain, or swelling of the legs

Good to know

• Doxorubicin can affect the heart. You will have heart ultrasounds (echocardiograms) during and after treatment.
• Ifosfamide and cyclophosphamide can damage the bladder. Mesna and lots of IV fluids protect it, and urine is checked for blood.
• Ifosfamide can affect the kidneys and the brain, so kidney blood tests are done often and you are watched for confusion.
• This treatment can cause infertility. Ask about sperm banking or egg freezing before you start.
• Long term follow up is needed for late effects on the heart, kidneys, fertility and a small risk of a second cancer.

At home

• Check your temperature twice a day and call right away for fever; do not take fever medicine first.
• Keep your port or line dressing clean and dry.
• Drink plenty of fluids between hospital stays.
• Give booster shots on schedule, or come to clinic for them.
• Avoid crowds, sick people and raw or undercooked foods when counts are low.

Questions to ask

• Will my cycles be every 2 weeks or every 3 weeks?
• Which cycles need a hospital stay?
• Will I have surgery, radiation or both for the main tumor?
• What can I do to protect my fertility?
• What late effects should I watch for after treatment?

Sarcoma

Last updated: 2026-10-27. Medically reviewed by Veli Bakalov, MD, medical oncologist (October 2026). General education from Step by Step, the patient portal of HemeOncBuddy.