High Dose Ifosfamide in Relapsed and Unresectable High-Grade Osteosarcoma Patients: A Retrospective Series
Open accessAbstract
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”
From Nivolumab and sunitinib in patients with advanced bone sarcomas: A multicenter, single‐arm, phase 2 trial (2025) · cites this paper as [2]
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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
- ORCID
- Venue
- Cells
- Publisher
- MDPI AG
- Published
- 2020-10-31
- Volume
- 9
- Issue
- 11
- Pages
- 2389
- ISSN
- 2073-4409 (ISSN-L)
- PMC
- PMC7692098
- 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
- gold
- doi.org
- Licence
- 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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Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
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