PARIS, France--Although the role of chemotherapy in the management
of osteosarcoma was once controversial, a plethora of clinical
studies now leave no doubt that chemotherapy dramatically brightens
the outlook for patients with this disease.
Still open to debate, however, is which drugs most improve disease-free
survival, and whether chemotherapy is best administered before
and after surgery or simply after surgery.
Two randomized multicenter studies conducted in the United States
and Europe have recently tackled these thorny questions, and results
were presented at the Fifth International Congress on Anti-Cancer
Chemotherapy, along with details of new studies in progress.
The latest neoadjuvant therapy trial from the EORTC-MRC (the European
Organization for Research and Treatment of Cancer--Medical Research
Council) randomized more than 400 osteosarcoma patients to receive
doxorubicin, 25 mg/m² on days 1 and 3, plus cisplatin (Platinol),
100 mg/m² on day 1, every 3 weeks, or the modified T10a regimen
developed at Me-morial Sloan-Kettering Cancer Center.
Dr. Allan van Oosterom, of the University of Antwerp (Belgium),
reported that after a median follow-up period of 3.1 years, survival
in both patient groups was identical. The 5-year disease-free
survival of roughly 60% compared favorably with previous results
from the EORTC-MRC investigators and from other groups, he said.
Dr. van Oosterom stressed, however, that the doxorubicin-cisplatin
combination offered equal efficacy at nearly a third the cost
of the more complicated polydrug T10a regimen.
The EORTC-MRC team rejected the inclusion of ifosfamide (Ifex)
as a next step, for fear of possible side effects. Instead, their
new study is comparing the tried-and-true doxorubicin-cisplatin
regimen given every 3 weeks with a more intensified version given
every 2 weeks, and supported with granulocyte colony-stimulating
factor (G-CSF, Neupogen), 250 mcg/m² on days 1 to 10, and,
when necessary, peripheral blood progenitor cell (PBPC) transplantation.