Osteosarcoma medical therapy

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Mohammadmain Rezazadehsaatlou[2].

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Overview

The predominant therapy for osteosarcoma is neoadjuvant chemotherapy (chemotherapy given before surgey) followed by surgical resection. The most common drugs used to treat osteosarcoma are cisplatin, doxorubicin and high-dose methotrexate. Ifosfamide can be used as an adjuvant treatment if the necrosis rate is low. Samarium is a radioactive drug that targets areas where bone cells growing, such as tumor cells in the bone. It relieves bone pain.

Medical Therapy

• Current standard treatment for osteosarcoma is to use neoadjuvant chemotherapy (chemotherapy given before surgery) followed by surgical resection.
• The percentage of tumor cell necrosis (cell death) seen in the tumor after surgery gives an idea of the prognosis and also lets the oncologist know if the chemotherapy regimen should be altered after surgery.
• Standard therapy is a combination of limb-salvage orthopedic surgery and a combination of high dose methotrexate with leucovorin rescue, intra-arterial cisplatin, caffeine, adriamycin, ifosfamide with mesna, BCD, etoposide, and muramyl tri-peptite (MTP).
• Fluids are given for hydration.
• Drugs like granisetron and ondansetron help with nausea and vomiting.
• Filgrastim, epoetin alfa, granulocyte colony stimulating factor help with white blood cell counts and neutrophil counts.
• Blood helps with anemia.

Chemotherapy regimens

• The most common chemotherapy combinations used to treat osteosarcoma are:

• Cisplatin, doxorubicin and high-dose methotrexate.
• Cisplatin and doxorubicin.

• Ifosfamide can be used as an adjuvant treatment if the necrosis rate is low.

Samarium

• Samarium is a radioactive drug that targets areas where bone cells growing, such as tumor cells in the bone.
• It helps relieve pain caused by cancer in the bone.
• It also kills the blood cells in bone marrow.
• Treatment with samarium may be followed by stem cell transplant.
• Before treatment with samarium, stem cells (immature blood cells) are removed from the blood or bonemarrow of the patient and are frozen and stored. After treatment with samarium is complete, the stored stem cells are thawed and given back to the patient through an infusion. These re-infused stem cells grow into (and restore) the body's blood cells.