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Methotrexate–Etoposide–Ifosfamide Compared with Doxorubicin–Cisplatin–Ifosfamide Chemotherapy in Osteosarcoma Treatment, Patients Aged 18–25 Years

2019; Mary Ann Liebert, Inc.; Volume: 9; Issue: 2 Linguagem: Inglês

10.1089/jayao.2019.0085

2156-535X

Perrine Marec‐Bérard, Valérie Laurence, Bob-valery Occean, Isabelle Ray‐Coquard, Claude Linassier, Nadège Corradini, Olivier Collard, L. Chaigneau, Didier Cupissol, Pierre Kerbrat, Esma Saada‐Bouzid, Corinne Delcambre, F. Gouin, Cécile Guillemet, Marta Jimenez, Cyril Lervat, Nathalie Gaspar, Marie‐Cécile Le Deley, Laurence Brugières, Sophie Piperno‐Neumann,

Chemotherapy-induced organ toxicity mitigation

Purpose: The French standard chemotherapy for osteosarcoma combines high-dose methotrexate (HDM) and etoposide-ifosfamide (EI) in children and adolescents, and API-AI (doxorubicin-cisplatin-ifosfamide) in adults. We herein present the results of M-EI and API-AI in 18- to 25-year-old patients. Methods: Patients, 18-25 years old, received either M-EI or API-AI regimens. M-EI comprised seven M and two EI doses preoperatively then M-EI in standard-risk patients (good histological response without metastasis) and five M-AP (methotrexate-doxorubicin-cisplatin) in high-risk patients (poor histological response, metastasis, and/or unresectable primary), postoperatively. API-AI comprised three API and two AI doses preoperatively, then two AI and two PI in standard-risk patients and five EI in high-risk patients, postoperatively. Results: We analyzed 95 patients 18-25 years of age: 55 received M-EI and 40 API-AI. The groups had similar baseline characteristics. Eighty-nine patients (94%) had surgery. Twenty-nine of 55 M-EI patients (60%) and 16/40 API-AI patients (41%) had good histological responses to preoperative chemotherapy. At 5 years, event-free survival was 50% (95% confidence interval [CI]: 39-60) and overall survival was 65% (95% CI: 54-74). Acute toxicity was similar, without treatment-related deaths. Conclusions: Survival outcomes with M-EI and API-AI were not significantly different. Tolerance was acceptable with both regimens. HDM is thus feasible for young adults. However, our study limitations preclude any definitive conclusions.