0.5 mg/ml and 2 mg/ml in 5% dextrose results in solutions exhibiting no 
decomposition for at least 24 hours at room temperature. The use of 0.9% 
sodium chloride is not recommended because increased rates of decomposition 
have been observed . The single-use lyophilized dosage form contains no 
antibacterial preservatives. Therefore, it is advised that the reconstituted 
product be discarded eight hours after initial entry. 
Frequent toxicities include myelosuppression, especially thrombocytopenia, 
nausea and vomiting; audiologic and reversible renal toxicity may occur. 
Alopecia, allergic reactions, hepatic dysfunction, hyponatremia, pulmonary 
toxicity (interstitial pneumonitis), amenorrhea, weight loss, fever, dizziness and 
blurred vision are rare toxicities. It is administered intravenously on an q.o.d. 
X 3 schedule. The daily dose will be dissolved in 100 cc/m^ D5W and infused 
over one hour. 
9.2 VP-16 (Etoposide, Vepesid) 
Commercially available, a semisynthetic epipodophyllotoxin, it inhibits DNA 
synthesis by strand scission. The mean terminal half-life is 11 hours with a 
range of 3 to 15 hours and is primarily excreted in the urine. The drug is 
commercially available in 100 mg (5 ml) sterile vials, as a yellow solution with 
a pH of 3 to 4. The intact vials are stable for 3 years at room temperature. 
When reconstituted with equal volume of 0.9% sodium chloride injection to 
a concentration of 0.4 mg/ml, the solution is stable for 48 hours at room 
temperature. Administration will be intravenously over 6 hours on q.o.d. (24 
hours after the carboplatin dose) x 3 schedule. The daily dose of VP-16 will 
be prepared in D5 1/4 NSS. Severe hypotension may occur if the drug is given 
rapidly. Toxicities include myelosuppression, stomatitis, nausea, anorexia, 
diarrhea, alopecia, and hepatic dysfunction. 
10.0 PATIENT ELIGIBILITY 
10.1 Any patient under 21 years of age at initial diagnosis with relapsed or 
refractory neuroblastoma with no marrow involvement. 
10.2 Performance status (SCOG) of 0-2 and life expectancy of >6 weeks. 
10.3 Adequate renal function (creatinine <1.8 mg/dl) and adequate hepatic 
function (SGOT or SGPT <3 x normal, bilirubin <1.5 mg/dl). 
10.4 Autologous marrow available for reinfusion without histologic evidence of 
tumor. 
Recombinant DNA Research, Volume 14 
[723] 
