APHON Pediatric Chemotherapy-Biotherapy Renewal

Cardiac effects. Tyrosine kinase inhibitors are associated with T prolongation. Table 5 provides an overview of side effects commonly seen in patients who are receiving small molecule inhibitors, grouped according to their target.

Table 5: Small Molecule Inhibitors Currently Being Used or Investigated in Pediatric Oncology (the list is not all inclusive)

Agent ( FDA-approved for pediatric use in bold print, with date of approval)

Common Side Effects by Target

Pediatric Indications (FDA-approved pediatric indications in bold print) Neuroblastoma Anaplastic large cell lymphoma

Type

Target

Receptor tyrosine kinase (RTK) inhibitors

Crizotinib

ALK, cMET Nausea and vomiting Diarrhea Elevated liver enzymes ALK, ROS1 Elevated liver enzymes Rashes

These agents target receptors on the surface of a cell.

Ensartinib

Recurrent or refractory ependymoma

EGFR

Skin rashes Mucositis

Erlotinib (2015) Gefitinib

Refractory solid tumors with NTRK mutations

NTRK

Cytopenia Elevated liver enzymes Hypertension Fatigue Diarrhea Rashes Hypothyroidism

Larotrectinib (2018) Entrectinib (2019)

Multikinase inhibitors

Pazopanib

Sarcomas Relapsed and refractory solid or CNS tumors

VEGFR, PDGFR

These agents can target cell surface receptors as well as signaling proteins inside a cell.

Ponatinib

Ewing sarcoma

VEGFR, FLT3

Sorafenib

Acute myeloid leukemia

VEGFR, PDGFR, RAF, RET VEGF, PDGF, FLT3, cKIT

Refractory solid tumors

Sunitinib (2019)