Perspectives of the Role of Chemotherapy in the Management of Osteosarcoma

Abstract

Background: Multimodality management of osteosarcoma has significantly improved the 5-year-survival rate for localized disease over the past 40 years: from 5% - 10% (in historical controls) to 65% - 75% and 20% - 30% in metastatic disease. These results were achieved with doxorubicin, cisplatin, high-dose methotrexate and ifosfamide (or cyclophosphamide). In the absence of new and effective agents the results have remained stationary for at least the past 30 years. No standard second line therapy exists for patients who relapse. In these circumstances surgery when feasible, constitutes the main therapeutic option. Questions/Purposes: To understand the present approach to therapy and determine the possibilities for improvement a review of the chemotherapeutic agents currently deployed in the treatment of Osteosarcoma was undertaken. Methods: The review focused on the results achieved with the evolution of therapy following the discovery of effective chemotherapeutic agents. Results: There was an improvement in survival during the first decade following the introduction of effective chemotherapy and limb salvage replaced amputation in the majority of patients. Attempts to rescue pulmonary metastases patients with surgical intervention were also enhanced but produced only minor improvement in survival. An international collaborative study, EURAMOS has been launched to investigate the utility of neoadjuvant chemotherapeutic agents in improving survival based upon their efficacy in the treatment of the primary tumor. Conclusions: New agents and or new strategies are urgently required to improve the outcome in Osteosarcoma

Osteosarcoma journey over two decades in India: Small steps, big changes

“…The OGS‐12 protocol resulted in good HR in 58% patients, which is similar to HDMTX‐based regimens such as MSKCC (65%), Cooperative German–Austrian–Swiss osteosarcoma study group (COSS) protocol (43%), and INT0133 (48%) and to non‐HDMTX‐based regimens such as OS‐99 (61%) and OS‐91 (51%), including those from India . Good histological response was similar with all the three protocols; however, the survival was better with OGS‐12 protocol.…”

“…A trend toward lesser hematological toxicity may be ascribed to the use of CDDP, which is less myelosuppressive than carboplatin used in the St Jude's study . Additionally, primary G‐CSF prophylaxis and targeted nutritional support might also have had a positive impact . This also led to improved compliance, with 86% of our patients completing adjuvant treatment.…”

“…Therefore, it is imperative to redistribute the allocated limited resources efficiently so as to bring about meaningful improvements in outcomes. This connotes eliminating inefficient and expensive interventions with limited benefit and adopting smart ways to deliver the best care to the patients and to the community as a whole …”

Ionizing radiation received by patients with osteosarcoma during intra-arterial chemotherapy treatment

“…El objetivo del tratamiento con quimioterapia administrada por vía intraarterial es aumentar la concentración del fármaco en la localización del tumor para incrementar la necrosis del tejido tumoral, reduciendo así la incidencia de recidivas locales y haciendo posible la resección completa de la lesión en mayor número de casos 6 . A falta de datos previos, el presente estudio cuantifica de manera objetiva la cantidad de radiación ionizante que los pacientes en edad adolescente afectos de os- teosarcoma reciben a través de pruebas de radiología intervencionista.…”

Osteosarcoma Journey in India: Each Step Reveals a New Horizon!

“…However, even in high-income countries, the outcomes are largely static since the past three decades. [1] Osteosarcoma therapy protocols mainly utilize a dyad backbone of cisplatin and doxorubicin, with the addition of a third drug, either ifosfamide or high-dose methotrexate (HDMTX), which has led to rapid strides forward in survival in osteosarcoma. [1]…”