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Neutropenia and anaemia: case report A 42-year-old man developed neutropenia and anaemia during treatment with cyclophosphamide, etoposide and tamoxifen for metastatic Ewing sarcoma (ES) The man, who was diagnosed with disseminated metastatic ES in June 2015, started receiving radiotherapy to the primary site for severe pain. He also started receiving oral metronomic chemotherapy (OMCT) protocol consisting cyclophosphamide 50 mg/m2, etoposide 50 mg/m2 once daily (capping at 50mg) for 21 days and tamoxifen 20 mg/m2 twice daily (capping at 20mg twice daily), repeated every 28 days. He achieved a symptomatic relief at the first follow-up with good tolerance. During 1.5 years of therapy, he developed toxicities including grade 2 neutropenia and grade 3 anaemia, which were partially attributed to coexisting nutritional deficiencies [time to reactions onsets not clearly stated]. The doses of cyclophosphamide, etoposide and tamoxifen were then adjusted to 50%. The tolerance improved following correction of deficiencies and dose adjustment. Sequential FDG PET/CT scans over 3 years showed partial metabolic response in primary and complete metabolic response (CMR) in the metastatic sites and post 3 years CMR at all sites. As the cumulative doses of cyclophosphamide and etoposide were over 5g each, the decision was made to stop the OMCT and observe. At the last follow-up, 4.5 years from diagnosis, he was alive without any disease. Mailankody S, et al. Widely disseminated metastatic Ewing sarcoma: Sustained, complete metabolic response to first-line oral metronomic chemotherapy. Pediatric Blood and 803504136 Cancer 67: e28375, No. 9, Sep 2020. Available from: URL: http://doi.org/10.1002/pbc.28375

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Reactions 3 Oct 2020 No. 1824