MBCL-33. RARE PULMONARY TOXICITY IN THREE MEDULLOBLASTOMA PATIENTS UNDERGOING ANTIANGIOGENIC METRONOMIC COMBINATION THERAPY

BACKGROUND: Metronomic and targeted anti-angiogenesis therapy (MEMMAT) has emerged as a promising treatment for recurrent/progressive medulloblastoma. This treatment includes bevacizumab, oral agents (thalidomide, celecoxib, fenofibrate, etoposide & cyclophosphamide) and intrathecal chemotherapy (etoposide & cytarabine). Common toxicities include myelosuppression, nausea, and infection. Mild respiratory toxicities can occur. We report three cases with significant respiratory toxicity. METHODS: An IRB approved chart review was performed of three children with recurrent medulloblastoma on MEMMAT treatment and meaningful pulmonary toxicity. Literature review found no reports of similar findings. RESULTS: Patient ages ranged from 3 to 11 years old. Patients completed a mean of 6.33 months on treatment. There was no history of chronic respiratory disease prior to starting MEMMAT. Patient #1 developed chronic cough requiring multiple respiratory and anti-infective treatments; CT scan demonstrated airspace opacities concerning for chronic inflammatory change. Each new viral infection led to significant respiratory distress. He eventually died from respiratory failure with large cystic lesions noted on CT. Patient #2 developed a chronic cough not responsive to antibiotics or respiratory treatments. Images reported airspace disease, bronchiectasis, and chronic inflammatory state. Patient #3 developed chronic cough without improvement despite antibiotics and inhaled respiratory treatments; images were suggestive of small airway disease. All three patients required numerous hospitalizations and additional treatment. CONCLUSION: With MEMMAT, many side effects are expected though respiratory symptoms have rarely been reported. Our cases highlight the possible important correlation of pulmonary toxicity while being treated on MEMMAT, and its impact on patients’ overall health and quality of life.