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A retrospective study of 427 pediatric patients between 2016 and 2023 found that four patients developed left ventricular dysfunction during treatment for various cancers. Patient 1, a 12-year-old girl with ewing sarcoma, developed dysfunction after receiving cyclophosphamide, ifosfamide, vincristine, dactinomycin, and etoposide. Patient 2, a 14-year-old boy with osteosarcoma, developed dysfunction after receiving methotrexate, cisplatin, and mifamurtide. Patient 3, a 15-year-old boy with lymphoma, developed dysfunction after receiving cyclophosphamide, vincristine, and procarbazine. Patient 4, a 1-year-old boy with medulloblastoma, developed dysfunction after receiving cyclophosphamide, methotrexate, vincristine, etoposide, and carboplatin. Genetic testing revealed potential genetic factors contributing to the dysfunction in each patient. [Extracted from the article]

An 18-year-old woman developed cardiotoxicity leading to myocarditis while undergoing treatment for extra-osseous Ewing's sarcoma/primitive neuroectodermal tumor. She experienced worsening dyspnea and was hospitalized, where she exhibited symptoms such as tachypnea, elevated pulse rate, and low blood pressure. Further examination revealed chemotherapy-related cardiotoxicity, and she was treated with various medications, leading to improvement. The woman's condition was confirmed to be myocarditis, and she received additional treatment, resulting in a gradual improvement of symptoms. [Extracted from the article]

A 19-year-old woman experienced holocephalic headaches while being treated with temozolomide for a specific type of brain tumor. She also showed lack of effectiveness when treated with levetiracetam for seizures, and intentionally misused the medication. The woman presented with involuntary jerking symptoms in her leg, which progressed to rhythmic movements in her foot. Further investigation revealed the presence of a rare brain tumor with metastasis to the bones. The woman underwent chemotherapy and radiotherapy, which resulted in seizure-free periods and overall improvement in her condition. [Extracted from the article]

A 20-year-old man with metastatic Ewing's sarcoma developed adrenal insufficiency while being treated with metyrapone and ketoconazole for Cushing syndrome. He also experienced lack of efficacy with multiple chemotherapy treatments for his sarcoma. The patient was admitted to the hospital for acute psychosis and exhibited symptoms such as truncal obesity, facial and leg edema, and hypokalemia. Despite treatment, his condition deteriorated, and he eventually died from fulminant hepatic insufficiency due to new liver metastases. The adrenal insufficiency was attributed to the medications metyrapone and ketoconazole. [Extracted from the article]

A 29-month-old boy with osseous Ewing sarcoma exhibited lack of efficacy during treatment with doxorubicin, etoposide, and ifosfamide. The boy initially presented with swelling and pain in his arm after a fall, and a tumorous mass with a fracture was discovered. Despite receiving five cycles of chemotherapy, the sarcoma did not respond to the treatment. The boy's chemotherapy was changed, and he underwent surgery to remove the sarcoma. After further treatment and follow-up, he showed normal growth and development with no recurrence of the disease. [Extracted from the article]

In a retrospective study involving six pediatric patients with various types of tumors, it was found that ifosfamide, carboplatin, and cisplatin treatment led to the development of encephalopathy. The patients experienced symptoms such as stupor, seizures, memory loss, and confusion within 24-72 hours of receiving ifosfamide. Treatment with methylene blue, dexamethasone, lorazepam, or levetiracetam resulted in the resolution of symptoms within 12-72 hours. Four out of six patients were re-challenged with ifosfamide, and one of them experienced a repeat episode of encephalopathy. [Extracted from the article]

A 48-year-old woman with a history of breast cancer developed various toxicities and lack of efficacy during treatment for Ewing's sarcoma. She experienced adverse effects such as neutropenia, increased liver enzymes, and kidney dysfunction while taking entrectinib and larotrectinib. Despite receiving multiple chemotherapy regimens, her tumor continued to grow. She was then treated with temozolomide and irinotecan, followed by entrectinib and larotrectinib, which stabilized her disease. However, she experienced additional side effects and was also infected with COVID-19. Despite these challenges, her disease remained under control for more than 21 months on larotrectinib. [Extracted from the article]

A 32-month-old girl experienced vomiting, anaemia, and thrombocytopenia while undergoing treatment for intracranial extra-osseous Ewing's sarcoma. She received craniospinal irradiation followed by adjuvant chemotherapy with vincristine, doxorubicin, cyclophosphamide, ifosfamide, and etoposide. Despite experiencing grade 2 vomiting, anaemia, and thrombocytopenia as side effects of the treatment, she tolerated it well and was disease-free after one year of completing the treatment. [Extracted from the article]

A case study published in Reactions Weekly describes the experience of an adult man with metastatic Ewing's sarcoma who exhibited a lack of efficacy during treatment with gemcitabine and docetaxel. Subsequently, he developed subclinical hypothyroidism, adrenal insufficiency, and hypogonadism during treatment with toripalimab. The man's symptoms were successfully managed with prednisone and levothyroxine, and he remained alive with stable disease after discontinuation of toripalimab for a year. Hormonal follow-up tests revealed normal levels of various hormones. [Extracted from the article]

A 60-year-old man with extraskeletal Ewing sarcoma experienced various toxicities and lack of efficacy during treatment with multiple antineoplastic drugs. He initially presented with a palpable mass, swelling, and pain in his left thigh, and was diagnosed with extraskeletal Ewing sarcoma. Despite receiving chemotherapy and radiation therapy, the disease progressed and metastasized, leading to the development of new lesions, pulmonary nodules, and lymphadenopathy. The patient also experienced complications such as neutropenic fever, syncopal episodes, severe fatigue, foot drop, and decreased sensation in his left leg. He ultimately died due to respiratory distress and malignant pleural effusions. [Extracted from the article]

However, all patients developed vincristin, cyclophosphamide and topotecan related grade 3-4 anaemia and 10 patients died due to progressive disease despite treatment with vincristin, cyclophosphamide and topotecan (lack of efficacy). Additionally, 10 of the 11 patients exhibited lack of efficacy during chemotherapy with vincristine, cyclophosphamide and topotecan [ I routes, durations of treatments to reactions onsets and outcomes not stated i ]. [Extracted from the article]

Following diagnosis, she started receiving first-line chemotherapy with vincristine, doxorubicin and cyclophosphamide. However, despite receiving the five cycles of vincristine, doxorubicin and cyclophosphamide, disease progression with enlargement of the hepatic and peritoneal tumours was confirmed, indicating lack of efficacy. Her chemotherapy with vincristine, doxorubicin and cyclophosphamide was discontinued, and she was shifted to lenvatinib, ifosfamide and etoposide. [Extracted from the article]

Right heart catheterization (RHC) confirmed the diagnosis of severe precapillary PAH with pulmonary artery wedge pressure (PAWP) 5 mmHg, mean pulmonary arterial pressure (mPAP) 32 mmHg, cardiac index (CI) 1.8 L/min/m SP 2 sp and pulmonary vascular resistance (PVR) 8.5WU. She received treatment with first-line chemotherapy combining doxorubicin, vinblastine, bleomycin and dacarbazine, then an external radiotherapy treatment followed by a second line treatment combining dexamethasone, cisplatin and cytarabine and a third-line treatment combining doxorubicin, etoposide and ifosfamide. She received two lines of chemotherapy, including vincristine, ifosfamide, etoposide and doxorubicin as the first line treatment followed by vincristine, actinomycin A and ifosfamide as the second-line treatment. [Extracted from the article]

However, despite receiving treatment with irinotecan, temozolomide, cyclophosphamide, topotecan, melphalan, treosulfan and trabectedin his disease continued to progress (indicating treatment failure). He consequently experienced the multifocal relapse of the sarcoma with multiple bone metastases therefore, relapse treatment with alternative cycles of irinotecan and temozolomide or cyclophosphamide and topotecan, high dose melphalan and treosulfan follwed by mainatinance therapy with trabectedin and irinotecan. B Author Information b An event is serious (based on the ICH definition) when the patient outcome is: * death * life-threatening * hospitalisation * disability * congenital anomaly * other medically important event In a study performed between January 2016 and October 2021 involving 6 child patients, undergoing cell-free circulating tumor DNA quantification for the monitoring of Ewing's sarcoma; an 11-year-old boy was described, who experienced treatment failure during treatment with irinotecan, temozolomide, cyclophosphamide, topotecan, melphalan, treosulfan, trabectedin, crizotinib and vorinostat [ I routes and dosages not stated i ]. [Extracted from the article]

B Author Information b An event is serious (based on the ICH definition) when the patient outcome is: * death * life-threatening * hospitalisation * disability * congenital anomaly * other medically important event In a study of 7 patients with Ewing sarcoma, who received pazopanib in addition to cytotoxic chemotherapy, et al. patients [ I ages and sexes not stated i ] were described, who developed whitening of hair and hepatotoxicity during treatment with pazopanib for Ewing sarcoma [ I routes, durations of treatments to reactions onsets and outcomes not stated i ]. The patients, who had history of Ewing sarcoma, received radiotherapy initially, and then started on maintenance therapy with pazopanib 200-400 mg/day, which was increased to 400-800 mg/day. Another patient developed mild hepatotoxicity, and at the month 8 of treatment, the pazopanib treatment was discontinued. [Extracted from the article]

B Author Information b An event is serious (based on the ICH definition) when the patient outcome is: * death * life-threatening * hospitalisation * disability * congenital anomaly * other medically important event A 20-year-old man developed neutropenic fever during treatment with doxorubicin, cyclophosphamide, mensa, ifosfamide and etoposide for Ewing sarcoma [ I routes not stated; not all dosages stated i ]. After 3 weeks of surgery, he received 14 cycles of vincristine 2 mg/m SP 2 sp , doxorubicin [adriamycin] 75 mg/m SP 2 sp and mensa which was then altered with ifosfamide 1800 mg/m SP 2 sp and etoposide 100 mg/m SP 2 sp . He had been taking paracetamol and naproxen to control his pain, but his pain got worsened along with onset of bilateral lower extremities weakness and numbness, which prompted him to the hospital. [Extracted from the article]

Subsequently, he developed anorexia, nausea, vomiting, fatigue, diarrhoea, leucopenia, neutropenia, increased alanine aminotransferase concentration and increased aspartate aminotransferase concentration within grade 3. Anorexia, nausea, vomiting, fatigue, diarrhea, leucopenia, neutropenia, increased alanine aminotransferase concentration and increased aspartate aminotransferase concentration were attributed to doxorubicin, vincristine, cyclophosphamide, ifosfamide, etoposide and catequentinib. B Author Information b An event is serious (based on the ICH definition) when the patient outcome is: * death * life-threatening * hospitalisation * disability * congenital anomaly * other medically important event A 26-year-old man developed anorexia, nausea, vomiting, fatigue, diarrhoea, leucopenia, neutropenia, increased alanine aminotransferase concentration and increased aspartate aminotransferase concentration during treatment with doxorubicin, vincristine, cyclophosphamide, ifosfamide, etoposide and catequentinib for primary Ewing's sarcoma in sphenoid sinus [ I routes, durations of treatments to reactions onsets and outcomes not stated i ]. [Extracted from the article]

She was commenced on therapeutic anticoagulation therapy with heparin [unfractionated heparin] and enoxaparin sodium [Lovenox] for pulmonary embolism (PE) and intracardiac thrombus for a period of 14 days. He was commenced on therapeutic anticoagulation therapy with heparin [unfractionated heparin] and enoxaparin sodium [Lovenox] for intracardiac tumour thrombus for a period of 28 days with no change in thrombus size. He was commenced on prophylactic anticoagulation therapy with heparin [unfractionated heparin] and enoxaparin sodium [Lovenox] for IVC and intracardiac thrombus for a period of 5 days with no change in thrombus size. [Extracted from the article]