For patients under 40 years with high-grade osteosarcoma, multi-agent MAP chemotherapy — high-dose methotrexate, doxorubicin and cisplatin — combined with surgery is the standard first-line approach. When MAP does not achieve a histological necrosis rate greater than 90% after neoadjuvant treatment, management must escalate. This protocol addresses that specific situation.
First-line treatment comprised neoadjuvant MAP chemotherapy, followed by surgical resection, followed by adjuvant MAP chemotherapy. The key response criterion — histological necrosis greater than 90% after neoadjuvant chemotherapy — was not reached. This failure of response is the trigger for this protocol.
Patient is under 40 years of age with confirmed high-grade osteosarcoma and no intolerance to high-dose methotrexate, requiring management following an insufficient necrosis response to first-line MAP-based therapy.
DOI: 10.1038/s41416-024-02868-4
The most widespread regimen is multi-agent therapy with MAP (high-dose methotrexate (HDMTX), doxorubicin and cisplatin) and is recommended for UK patients with potentially resectable tumours up to 40 years of age.
Treatment for recurrent osteosarcoma should include surgical resection if complete surgical clearance is possible.
Ifosfamide and etoposide are associated with the highest response rates.
Multi-targeted tyrosine kinase inhibitors (MTKIs) including cabozantinib, regorafenib and lenvatinib have demonstrated single-agent activity in phase II clinical trials.
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