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(Drug information on doxorubicin), 25 mg/m² on days 1 and 3, plus cisplatin(Drug information on 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(Drug information on 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.