Table 1.

Suggested adaptations to chemotherapy in COVID-19 pandemic for non-metastatic Ewing sarcoma, Osteosarcoma and Rhabdomyosarcoma

Cancer	Conventional first-line protocol	Suggested adaptations during COVID-19 pandemic
Ewing Sarcoma	Vcr, Dox, Cyclo (VDC)/Ifos, Etop (IE) every 2 or 3 weeks Alternatives: Vcr, Ifos, Dox, Etop (VIDE) followed by VAC or VAI	Switching to 3 weekly schedules [26] Replace multiple daily GCSF with a single dose of PEG-GCSF Doxorubicin—infuse over 6 h in one day (75 mg/m2/day) [27] VAC instead of VAI is using Euro-Ewing protocol Additional chemotherapy can be given as local control can be delayed up to 15 weeks from the start of treatment [28] Consider 25% dose reduction if needed
Osteosarcoma	Two drugs: Cispl, Dox (AP) Three drugs: Ifos, Cispl, Dox (IAP); HDMtx, Cispl, Dox (MAP)	Switching to two drugs [29] Doxorubicin—Infuse over 6 h in one day (75 mg/m2/day) or 2 days (37.5 mg/m2/day) rather than 48-h infusion [26] Cisplatin can be given in two days (50–60 mg/m2/day) Consider IAP over MAP fro three-drug regimen as it reduces the frequency of chemotherapy and days in the hospital Use PEG-GCSF after each cycle Consider 25% dose reduction if needed
Rhabdomyosarcoma	Vcr, Act D, Cyclo (VAC) Alternatives: VAC/Vcr, Irin (VI); Vcr, Act D, Ifos (VAI) can be the other alternatives	Use VAC to reduce days in the hospital Omit weekly Vcr Additional Doxorubicin for high risk not of benefit [30] Use PEG-GCSF after each cycle Consider 25% dose reduction if needed