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Abstract: Background: Metronomic chemotherapy (MC) is the administration of chemotherapy at doses below the maximal tolerated dose on a frequent schedule of administration, with no prolonged drug-free breaks. Objective: The aim of this research was to assess the effectiveness and tolerance of a metronomic etoposide/ cyclophosphamide/celecoxib regimen in children and adolescents with refractory cancer. Methods: This retrospective, single-center study evaluated the use of MC with etoposide 25 mg/m2.d-1 (days 1-14), cyclophosphamide 25 mg/m2 d-1 (days 15-28), and celecoxib 100 to 400 mg/d (days 1-28), in children with refractory, or high-risk relapsing, cancer. Adverse events were determined through laboratory analyses and investigator observations. Results: From January 2005 to December 2007, 17 children and adolescents were treated. The best responses observed were stabilizations of the disease that lasted over 20 weeks in 7 patients (41%). Most importantly, in 4 patients (24%) antalgic treatment could be transiently diminished or stopped, and in 1 patient (6%) oxygen support could be stopped for several weeks. Four grade IV platelet toxicities were noted in 3 patients; 2 grade IV anemia occurred in 2 patients (who had platelet and red blood cell transfusions before initiation of treatment); and 1 patient had grade III neutropenia. No other grade III or IV toxicities were noted. Grade II alopecia and stomatitis were observed in 1 patient and grade II vomiting was observed in 2 patients. One patient with meningeal carcinomatosis developed bilateral subdural hematoma for which the role of MC could not be ruled out. Circulating endothelial cells were elevated in 3 out of 3 patients in whom they were quantified and who were progressing while under MC. Conclusion: The MC regimen we report here was associated with disease stabilization without major toxicities. This assessment of MC in children and adolescents warrants further studies. [Copyright &y& Elsevier]

Hepatoblastoma is the most frequent pediatric liver cancer. The current treatments lead to 80% of survival rate at 5 years. In this study, we evaluated the clinical relevance of molecular features to identify patients at risk of chemoresistance, relapse and death of disease. All the clinical data of 86 children with hepatoblastoma were retrospectively collected. Pathological slides were reviewed, tumor DNA sequencing (by whole exome, whole genome or target) and transcriptomic profiling with RNAseq or 300-genes panel were performed. Associations between the clinical, pathological, mutational and transcriptomic data were investigated. High-risk patients represented 44% of our series and the median age at diagnosis was 21.9 months (range: 0–208). Alterations of the WNT/ß-catenin pathway and of the 11p15.5 imprinted locus were identified in 98% and 74% of the tumors, respectively. Other cancer driver genes mutations were only found in less than 11% of tumors. After neoadjuvant chemotherapy, disease-specific survival and poor response to neoadjuvant chemotherapy were associated with 'Liver Progenitor' (p = 0.00049, p < 0.0001) and 'Immune Cold' (p = 0.0011, p < 0.0001) transcriptomic tumor subtypes, SBS35 cisplatin mutational signature (p = 0.018, p = 0.001), mutations in rare cancer driver genes (p = 0.0039, p = 0.0017) and embryonal predominant histological type (p = 0.0013, p = 0.0077), respectively. Integration of the clinical and molecular features revealed a cluster of molecular markers associated with resistance to chemotherapy and survival, enlightening transcriptomic 'Immune Cold' and Liver Progenitor' as a predictor of survival independent of the clinical features. Response to neoadjuvant chemotherapy and survival in children treated for hepatoblastoma are associated with genomic and pathological features independently of the clinical features. [Display omitted] • Identification of molecular features of chemoresistance and poor survival in HB. • These features are observed at the time of surgery, after neoadjuvant chemotherapy. • They are independent of the current risk stratification performed at diagnosis. • Includes 'Progenitor' and 'Immune cold' classifications, rare driver alterations. • SBS35 mutational signature shows specific resistance to platinum-based chemotherapy. [ABSTRACT FROM AUTHOR]

Background: Filgrastim is an effective granulocyte colony-stimulating factor (G-CSF) used to reduce periods of neutropenia and the risk of infection after chemotherapy courses. Pegfilgrastim is a pegylated filgrastim with a longer plasma half-life that is administered once per cycle. Objective: The aim of this study was to compare the efficacy of pegfilgrastim and filgrastim administered after chemotherapy in children with Ewing sarcoma. Methods: We performed a retrospective chart review of pediatric patients with Ewing sarcoma. Every patient received both types of G-CSF in different treatment courses of chemotherapy, which consisted of vincristine, ifosfamide, doxorubicin, and etoposide (VIDE); vincristine, actinomycin D, and ifosfamide (VAI); or vincristine, actinomycin D, and cyclophosphamide (VAC). A single injection of pegfilgrastim 100 μg/kg SC or a daily injection of filgrastim 5 to 10 μg/kg SC was administered 48 to 72 hours after the completion of chemotherapy. The following data were collected from the medical charts: proportion of chemotherapy courses with grade 4 neutropenia, duration of grade 4 neutropenia, proportion with severe neutropenia, duration of severe neutropenia, proportion with febrile neutropenia, duration of antibiotic treatment, duration of hospitalization, and percentage of patients receiving transfusion. Grade 4 neutropenia was defined as an absolute neutrophil count of <500 × 109/L; severe neutropenia was defined as a count of <200 × 109/L. Adverse events were collected from the medical charts. Results: Twenty children were included (13 girls and 7 boys). The patients'' median age was 12.8 years (range, 9–17 years) and median weight was 45.2 kg (range, 28–90 kg). A total of 178 chemotherapy courses (108 VIDE; 70 VAI or VAC) were administered and evaluated, including 134 courses with pegfilgrastim and 44 courses with filgrastim. Considering all types of chemotherapy combined, those courses in which pegfilgrastim was used were associated with a significantly lower incidence of severe neutropenia (0.21 vs 0.85; P = 0.03), a shorter duration of severe neutropenia (0.49 vs 2.36 days; P = 0.01), and a shorter duration of antibiotic treatment (1.07 vs 4.22 days; P = 0.03) compared with courses treated with filgrastim. No statistically significant differences were observed for the proportion and duration of grade 4 neutropenia, proportion of febrile neutropenia, duration of hospitalization, or red blood cell and platelet transfusions. Adverse effects were few and comparable between pegfilgrastim and filgrastim. Conclusions: In this retrospective chart review of children with Ewing sarcoma, using pegfilgrastim after chemotherapy courses was associated with significantly reduced frequency and shorter duration of severe neutropenia compared with those courses followed by filgrastim. Randomized controlled trials are needed to confirm these preliminary observations. [Copyright &y& Elsevier]