What is your therapy of choice for relapsed metastatic alveolar rhabdomyosarcoma?

I will make just a couple of presumptions. First, I will presume that this alveolar rhabdo is FOXO1-fusion positive. If not, I would treat as I would an embryonal (fusion negative) rhabdo with vinorelbine/PO cyclophosphamide, vinorelbine/cyclo/temsirolimus, vincristine/irinotecan +/- temozolomide, cyclo/topo, etc. Second, I would presume that when you say relapsed metastatic, you mean the patient was metastatic at diagnosis and now relapsed (as opposed to low stage at diagnosis and now relapsed ...