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Cited by 456Sarcoma Diagnosis and TreatmentBone Tumor Diagnosis and TreatmentsOvarian cancer diagnosis and treatment

Chemotherapeutic adjuvant treatment for osteosarcoma: Where do we stand?

Anninga, Jakob K., Gelderblom, Hans, Fiocco, Marta, Kroep, Judith R., Taminiau, Antoni H.M., Hogendoorn, Pancras C.W., Egeler, R. Maarten·2011·European Journal of Cancer
DOI 10.1016/j.ejca.2011.05.030
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Abstract

Aim Since the introduction of chemotherapy, survival in localised high-grade osteosarcoma has improved considerably. However, there is still no worldwide consensus on a standard chemotherapy approach. In this systematic review evidence for effectiveness of each single drug and the role of response guided salvage treatment of adjuvant chemotherapy are addressed, whereas in a meta-analysis the number of drugs in current protocols is considered.Methods A systematic literature search for clinical studies in localised high-grade osteosarcoma was undertaken, including both randomised and non-randomised trials. Historical clinical studies from the pre-chemotherapy era were included for comparison purposes.Results Nine historical studies showed a long-term survival of 16% after only local treatment. Fifty single agent phase II studies showed high response rates for adriamycin (A, 43%), ifosfamide (Ifo, 33%), methotrexate (M, 32%), cisplatin (P, 26%) but only 4% for etposide (E). In 19 neo-adjuvant studies the mean 5-year event free survival (EFS) was 48% for 2-drug regimens and 58% for ⩾3 drug regimens, with a 5-year overall survival (OAS) of 62% and 70%, respectively. Meta-analysis showed that ⩾3 drug regimens including methotrexate plus adriamycin plus cisplatin (plus ifosfamide) (MAP(Ifo)) had significant better outcome (EFS: HR=0.701 (95% confidence interval [95% CI]: 0.615-0.799); OAS: HR=0.792 (95% CI: 0.677-0.926) than 2-drug regimens, but there was no significant difference between MAP and MAPIfo (or plus etoposide). Salvage of poor responders by changing drugs, or intensifying treatment postoperatively has not proven to be useful in this analysis.Conclusion Meta-analysis in patients with localised high-grade osteosarcoma shows that 3-drug regimens, for example MAP are the most efficacious drug regimens.

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  • The most efficacious regimens employ at least three of these drugs, yet adding a fourth agent may not lead to further benefits.

    “The most efficacious regimens employ at least three of these drugs, yet adding a fourth agent may not lead to further benefits 128 .”

    From Osteosarcoma (2022) · cites this paper as [128]

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Authors
Anninga, J. K., Gelderblom, H., Fiocco, M., Kroep, J. R., Taminiau, A. H. M., Hogendoorn, P. C. W., & Egeler, R. M.
Affiliations
Leiden University Medical Center (NL)
Corresponding author
Gelderblom, Hans
ORCID
Venue
European Journal of Cancer
Publisher
Elsevier BV
Published
2011-11
Volume
47
Issue
16
Pages
2431-2445
ISSN
0959-8049 (ISSN-L)
DOI
10.1016/j.ejca.2011.05.030
OpenAlex
W2011551652
Cited by
456
References
142
Citations by year
2026: 11 · 2025: 22 · 2024: 31 · 2023: 25 · 2022: 38 · 2021: 42 · 2020: 45 · 2019: 43 · 2018: 22 · 2017: 31 · 2016: 34 · 2015: 44 · 2014: 29 · 2013: 30 · 2012: 7
FWCI
3.53
Type
journal article
Language
en
Open access
closed
Licence
www.elsevier.com/tdm/userlicense/1.0/ (tdm)
Locations
  • European Journal of Cancer (publishedVersion)
  • PubMed (publishedVersion)
  • Data Archiving and Networked Services (DANS) (submittedVersion)
  • Leiden Repository (Leiden University) (submittedVersion)
Topics
  • Health Sciences › Medicine › Pulmonary and Respiratory Medicine › Sarcoma Diagnosis and Treatment
  • Health Sciences › Medicine › Rheumatology › Bone Tumor Diagnosis and Treatments
  • Health Sciences › Medicine › Reproductive Medicine › Ovarian cancer diagnosis and treatment
Keywords
osteosarcoma, adjuvant chemotherapy, high-grade osteosarcoma, neoadjuvant chemotherapy, methotrexate, doxorubicin, ifosfamide, cisplatin, etoposide, salvage chemotherapy, event-free survival, overall survival
MeSH terms
Age Factors, Antineoplastic Agents, Antineoplastic Combined Chemotherapy Protocols, Cisplatin, Doxorubicin, Female, Humans, Ifosfamide, Male, Methotrexate, Osteosarcoma, Survival Analysis, Chemotherapy, Adjuvant

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