title: Use of granulocyte colony stimulating factor to reduce the toxicity of super-VAC chemotherapy in advanced solid tumours in childhood.
abstract: Children with advanced solid tumours at the Royal Alexandra Hospital for Children (RAHC) receive an intensive four drug chemotherapy combination, Super-VAC (cyclophosphamide, 500 mg/m2, adriamycin, 30 mg/m2, actinomycin-D, 0.5 mg/m2, all daily for 3 days, and vincristine, 1.5 mg/m2 weekly). The majority of patients respond well to three courses of such therapy, but with considerable morbidity, including fever, neutropenia, and mucositis. In an attempt to reduce the morbidity of Super-VAC, G-CSF was added. We documented various parameters in 12 patients who received 28 cycles with G-CSF and compared them to an historical control group of 37 cycles in the preceding 14 patients who received Super-VAC. The median duration of each cycle was 23 days with G-CSF and 28 days without G-CSF (P = 0.004). However, differences in requirements for inpatient care (median 16 v. 20 days), intravenous antibiotics (median 9 v. 10 days), amphotericin (median 5 v. 3 days), morphine (median 8.5 v. 7 days), or TPN (median 6.5 v. 8 days) did not reach statistical significance. As expected, a significant difference in neutrophil recovery was demonstrated between the two groups (median 11 v. 16 days, P < 0.0001) but not in platelet recovery (median 13 v. 13 days). The use of G-CSF with Super-VAC resulted in a shorter cycle length, so increasing the dose intensity. A reduction in morbidity could not be demonstrated. No toxic side effects from G-CSF were noted.
authors.affiliation: Department of Oncology, Royal Alexandra Hospital for Children, Camperdown, Sydney, Australia.
authors.forename: C A
authors.initials: CA
authors.lastname: Jones
authors.forename: P J
authors.initials: PJ
authors.lastname: Shaw
authors.forename: M M
authors.initials: MM
authors.lastname: Stevens
mesh_terms: D000293:Adolescent; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000009:adverse effects* / Q000627:therapeutic use; D002648:Child; D002675:Child, Preschool; D003520:Cyclophosphamide / Q000008:administration & dosage / Q000009:adverse effects; D003609:Dactinomycin / Q000008:administration & dosage / Q000009:adverse effects; D004317:Doxorubicin / Q000008:administration & dosage / Q000009:adverse effects; D005334:Fever / Q000517:prevention & control; D016179:Granulocyte Colony-Stimulating Factor / Q000009:adverse effects / Q000627:therapeutic use*; D006801:Humans; D007223:Infant; D009369:Neoplasms / Q000188:drug therapy*; D009503:Neutropenia / Q000517:prevention & control; D014750:Vincristine / Q000008:administration & dosage / Q000009:adverse effects
chemical_list: D016179:Granulocyte Colony-Stimulating Factor; D003609:Dactinomycin; D014750:Vincristine; D004317:Doxorubicin; D003520:Cyclophosphamide