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Off-label use, delirium and urticaria: 2 case reports In a single-institution retrospective analysis of 25 patients, who had soft tissue sarcoma and were treated between 2008 and 2017, two men in their sixties were described, who developed delirium or urticaria during treatment with etoposide, ifosfamide and pirarubicin for soft tissue sarcoma. Both patients received off-label treatment with pirarubicin for soft tissue sarcoma. Both patients had soft tissue sarcoma with a primary lesion at the inguinal site (1 patient) and buttock (1 patient). Subsequently, both patients started receiving IV infusion of off-label pirarubicin [Pinorubin, Nippon Kayaku] 30 mg/m2 on days 1 and 2, ifosfamide [Ifomide, Shinogi & Co. Ltd.] 2 g/m2 on days 1–5 and etoposide [Lastet Inj, Nippon Kayaku] 100 mg/m2 on days 1–3 of every 3 week cycle. Concomitantly, both patients also received granulocyte colony-stimulating factors for prophylaxis of febrile neutropenia and mesna. One patient had received one cycle of chemotherapy, while the other patient received two cycles of chemotherapy. Subsequently, both patients developed delirium (1 patient) and urticaria (1 patient) [times to reactions onsets not stated]. Hence, treatment with etoposide, ifosfamide and pirarubicin was stopped [outcomes not stated]. Saito S, et al. Efficacy of combination-chemotherapy with pirarubicin, ifosfamide, and etoposide for soft tissue sarcoma: A single-institution retrospective analysis. BMC 803519835 Cancer 20: No. 1, 9 Sep 2020. Available from: URL: http://doi.org/10.1186/s12885-020-07378-z

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Reactions 12 Dec 2020 No. 1834