What is the chemotherapy protocol for osteosarcoma with lung metastases (mets)?

From the Guidelines

Chemotherapy for osteosarcoma with lung metastases typically involves a multi-drug regimen, with the most recent and highest quality study recommending the use of doxorubicin, cisplatin, and ifosfamide, with or without high-dose methotrexate, depending on the patient's age and response to initial therapy 1. The standard protocol includes a combination of these drugs, usually administered over 10-12 weeks preoperatively, followed by surgical resection of the primary tumor and lung metastases when possible, then additional chemotherapy for 12-29 weeks postoperatively. Some key points to consider in the treatment of osteosarcoma with lung metastases include:

• The use of doxorubicin, cisplatin, and ifosfamide as the basis of treatment, with or without high-dose methotrexate, depending on the patient's age and response to initial therapy 1
• The importance of surgical resection of the primary tumor and lung metastases, when possible, to achieve complete removal of the tumor and improve survival rates 1
• The need for careful monitoring of blood counts, cardiac function, kidney function, and neurological status throughout treatment, due to the significant side effects of chemotherapy, including myelosuppression, cardiotoxicity, nephrotoxicity, and neuropathy 1
• The use of supportive care, including antiemetics, hydration, and growth factors, to manage side effects and improve quality of life during treatment 1 It's worth noting that the treatment of osteosarcoma with lung metastases is a complex and individualized process, and the specific chemotherapy regimen and treatment plan may vary depending on the patient's unique needs and circumstances. However, based on the most recent and highest quality study, the use of doxorubicin, cisplatin, and ifosfamide, with or without high-dose methotrexate, is the recommended approach for the treatment of osteosarcoma with lung metastases 1.

From the FDA Drug Label

An effective adjuvant chemotherapy regimen requires the administration of several cytotoxic chemotherapeutic agents In addition to high-dose methotrexate with leucovorin rescue, these agents may include doxorubicin, cisplatin, and the combination of bleomycin, cyclophosphamide and dactinomycin (BCD) in the doses and schedule shown in the table below. The starting dose for high-dose methotrexate treatment is 12 grams/m2 If this dose is not sufficient to produce a peak serum methotrexate concentration of 1,000 micromolar (10-3 mol/L) at the end of the methotrexate infusion, the dose may be escalated to 15 grams/m2 in subsequent treatments. Drug * Dose * Treatment Week After Surgery Methotrexate 12 g/m2 IV as 4 hour infusion (starting dose) 4,5,6,7,11,12,15,16,29,30,44,45 Leucovorin 15 mg orally every six hours for 10 doses starting at 24 hours after start of methotrexate infusion

Doxorubicin † as a single drug 30 mg/m2/day IV x 3 days 8,17 Doxorubicin † Cisplatin † 50 mg/m2 IV 100 mg/m2 IV 20,23,33,36 20,23,33,36 Bleomycin † Cyclophosphamide † Dactinomycin † 15 units/m2 IV x 2 days 600 mg/m2 IV x 2 days 0. 6 mg/m2 IV x 2 days 2,13,26,39,42 2,13,26,39,42 2,13,26,39,42

The chemotherapy protocol for osteosarcoma includes:

• High-dose methotrexate with leucovorin rescue, starting at 12 grams/m2, with possible escalation to 15 grams/m2
• Doxorubicin, 30 mg/m2/day IV x 3 days, or in combination with cisplatin, 50 mg/m2 IV and 100 mg/m2 IV
• Bleomycin, cyclophosphamide, and dactinomycin (BCD), in the doses and schedule shown in the table 2

From the Research

Chemotherapy Protocol for Osteosarcoma with Lung Metastases

The chemotherapy protocol for osteosarcoma with lung metastases typically involves a combination of drugs.

• The study 3 reports on the use of cisplatin, adriamycin, and high doses of methotrexate and ifosfamide as primary chemotherapy, followed by simultaneous resection of primary and metastatic lesions when feasible.
• Another study 4 compares the use of methotrexate, etoposide, and ifosfamide (M-EI) with doxorubicin, cisplatin, and ifosfamide (API-AI) in patients aged 18-25 years, but does not specifically focus on lung metastases.
• The MAP (methotrexate, doxorubicin, and cisplatin) regimen is confirmed as the gold standard for OS patients, including those with metastatic disease, in the study 5.

Treatment Outcomes

• The study 3 reports a 2-year disease-free survival (DFS) of 36% and overall survival (OS) of 53% in patients with osteosarcoma and lung metastases.
• The study 4 reports a 5-year event-free survival of 50% and overall survival of 65% in patients aged 18-25 years, but does not specifically report on lung metastases.
• The study 6 reports a tumor-free survival rate of 23% and an overall survival rate of 48% in patients treated with chemotherapy alone, but notes that surgery is often necessary to achieve cure.

Safety and Toxicity

• The study 7 highlights the importance of monitoring for acute and late toxicities of chemotherapy in osteosarcoma patients, particularly with the use of high doses of methotrexate.
• The study 5 notes that optimizing the use of active drugs available and personalizing chemotherapies may be important in improving outcomes for osteosarcoma patients.