Cited by 36Sarcoma Diagnosis and TreatmentBone Tumor Diagnosis and TreatmentsOvarian cancer diagnosis and treatment

High Dose Ifosfamide in Relapsed and Unresectable High-Grade Osteosarcoma Patients: A Retrospective Series

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Palmerini, Emanuela, Setola, Elisabetta, Grignani, Giovanni, D’Ambrosio, Lorenzo, Comandone, Alessandro, Righi, Alberto, Longhi, Alessandra, Cesari, Marilena +9 more·2020·Cells

Abstract

Background: The evidence on high-dose ifosfamide (HD-IFO) use in patients with relapsed osteosarcoma is limited. We performed a retrospective study to analyze HD-IFO activity. Methods: Patients with osteosarcoma relapsed after standard treatment [methotrexate, doxorubicin, cisplatin +/− ifosfamide (MAP+/−I)] with measurable disease according to RECIST1.1 were eligible to ifosfamide (3 g/m2/day) continuous infusion (c.i.) days 1–5 q21d. RECIST1.1 overall response rate (ORR) (complete response (CR) + partial response (PR)), progression-free survival at 6-month (6m-PFS), duration of response (DOR), and 2-year overall survival (2y-OS) were assessed. PARP1 expression and gene mutations were tested by immunohistochemistry and next-generation sequencing. Results: 51 patients were included. ORR was 20% (1 CR + 9 PR). Median DOR was 5 months (95%CI 2–7). Median PFS, 6m-PFS, OS, and 2y-OS were 6 months (95%CI 4–9), 51%, 15 months (10–19), and 30%, respectively. A second surgical complete remission (CR2) was achieved in 26 (51%) patients. After multivariate analysis, previous use of ifosfamide (HR 2.007, p = 0.034) and CR2 (HR 0.126, p < 0.001) showed a significant correlation with PFS and OS, respectively. No significant correlation was found between outcomes and PARP1 or gene mutations. Conclusions: HD-IFO should be considered as the standard first-line treatment option in relapsed osteosarcoma and control arm of future trial in this setting.

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  • Systemic treatment for advanced bone sarcoma progressing after upfront chemotherapy is challenging, with best results still leveraging ifosfamide for Ewing sarcoma and osteosarcoma, whereas evidence is limited in dedifferentiated chondrosarcoma, conventional chondrosarcoma, and other ultra-rare bone sarcomas.

    “Systemic treatment for advanced bone sarcoma (BS) progressing after upfront chemotherapy is challenging, with best results still leveraging on the use of ifosfamide both for Ewing sarcoma 1 and osteosarcoma, 2 , 3 whereas evidence is limited in dedifferentiated chondrosarcoma (DDCS), 4 conventional chondrosarcoma 5 and other ultra‐rare BS. 6”

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Authors
Palmerini, E., Setola, E., Grignani, G., D’Ambrosio, L., Comandone, A., Righi, A., Longhi, A., Cesari, M., Paioli, A., Hakim, R., Pierini, M., Marchesi, E., Vanel, D., Pignochino, Y., Donati, D. M., Picci, P., & Ferrari, S.
Affiliations
  • Istituto Ortopedico Rizzoli (IT)
  • Candiolo Cancer Institute (IT)
  • Ospedale San Giovanni Bosco (IT)
  • Italian Sarcoma Group (IT)
  • Orthopedic Oncology, IRCCS Istituto Ortopedico Rizzoli, 40136 Bologna, Italy
Corresponding author
D’Ambrosio, Lorenzo
Venue
Cells
Publisher
MDPI AG
Published
2020-10-31
Volume
9
Issue
11
Pages
2389
ISSN
2073-4409 (ISSN-L)
OpenAlex
W3096639263
Cited by
36
References
34
Citations by year
2026: 5 · 2025: 3 · 2024: 5 · 2023: 5 · 2022: 6 · 2021: 10 · 2020: 2
FWCI
3.24
Type
journal article
Language
en
Open access
Locations
  • Cells (publishedVersion, cc-by)
  • PubMed Central (publishedVersion, cc-by)
  • PubMed (publishedVersion)
  • Institutional Research Information System University of Turin (University of Turin) (submittedVersion, other-oa)
  • Archivio istituzionale della ricerca (Alma Mater Studiorum Università di Bologna) (submittedVersion, cc-by)
  • DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
Funders
European Commission
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
high-dose ifosfamide, relapsed osteosarcoma, continuous infusion chemotherapy, overall response rate, progression-free survival, overall survival, genetic mutations
MeSH terms
Poly (ADP-Ribose) Polymerase-1, Adolescent, Adult, Aged, Bone Neoplasms, Child, Cisplatin, Dose-Response Relationship, Drug, Doxorubicin, Female, Humans, Ifosfamide, Male, Methotrexate, Middle Aged, Mutation, Neoplasm Recurrence, Local, Retrospective Studies, Osteosarcoma, Treatment Outcome, Young Adult, High-Throughput Nucleotide Sequencing

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