Use of granulocyte colony stimulating factor to reduce the toxicity of super‐VAC chemotherapy in advanced solid tumours in childhood

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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.