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Dose-intense ifosfamide/doxorubicin/cisplatin based chemotherapy for osteosarcoma in adults.
Am J Clin Oncol 2002; 25(5):489-95AJ

Abstract

The efficacy of neoadjuvant and adjuvant chemotherapy has been clearly established in the treatment of osteosarcoma; however, the most active regimen remains to be identified. This prospective study evaluated the efficacy and toxicity of a dose-intense ifosfamide, doxorubicin, and cisplatin-based neoadjuvant regimen in adults with osteosarcoma. We prospectively treated 20 patients with osteogenic sarcoma with two cycles of ifosfamide/doxorubicin followed by two cycles of doxorubicin/cisplatin every 2 weeks. Surgical specimens were analyzed for percent tumor necrosis. Patients who demonstrated a "good response" (GR) to chemotherapy received the same combination postoperatively at a lower dose rate. Patients who demonstrated a "poor response" (PR) received four cycles of high-dose methotrexate alternating with two cycles of ifosfamide/etoposide and two cycles of cisplatin/etoposide after the surgery. Neoadjuvant chemotherapy was well tolerated with moderate hematologic toxicity. Twelve of 19 evaluable patients (63%) were treated according to the GR arm and 7 according to the PR arm. At median follow-up of 5.5 years, disease-free survival (DFS) and overall survival (OS) are 68% and 74%, respectively. Patients treated on the GR arm had DFS and OS of 75% and 83%, respectively, whereas patients on the PR arm had DFS and OS of 57%. Intensive neoadjuvant chemotherapy is effective and moderately well tolerated in patients with de novo osteosarcoma. The outcome data suggest that lack of a near complete response to preoperative chemotherapy reflects inherent biologic resistance to chemotherapy and hence a poor prognosis.

Authors+Show Affiliations

Division of Hematology and Oncology, University of Florida College of Medicine, Gainesville, Florida, USA.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Clinical Trial
Journal Article

Language

eng

PubMed ID

12393991

Citation

Patel, Shailesh J., et al. "Dose-intense Ifosfamide/doxorubicin/cisplatin Based Chemotherapy for Osteosarcoma in Adults." American Journal of Clinical Oncology, vol. 25, no. 5, 2002, pp. 489-95.
Patel SJ, Lynch JW, Johnson T, et al. Dose-intense ifosfamide/doxorubicin/cisplatin based chemotherapy for osteosarcoma in adults. Am J Clin Oncol. 2002;25(5):489-95.
Patel, S. J., Lynch, J. W., Johnson, T., Carroll, R. R., Schumacher, C., Spanier, S., & Scarborough, M. (2002). Dose-intense ifosfamide/doxorubicin/cisplatin based chemotherapy for osteosarcoma in adults. American Journal of Clinical Oncology, 25(5), pp. 489-95.
Patel SJ, et al. Dose-intense Ifosfamide/doxorubicin/cisplatin Based Chemotherapy for Osteosarcoma in Adults. Am J Clin Oncol. 2002;25(5):489-95. PubMed PMID: 12393991.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Dose-intense ifosfamide/doxorubicin/cisplatin based chemotherapy for osteosarcoma in adults. AU - Patel,Shailesh J, AU - Lynch,James W,Jr AU - Johnson,Thomas, AU - Carroll,Robert R, AU - Schumacher,Cynthia, AU - Spanier,Susanne, AU - Scarborough,Mark, PY - 2002/10/24/pubmed PY - 2002/11/26/medline PY - 2002/10/24/entrez SP - 489 EP - 95 JF - American journal of clinical oncology JO - Am. J. Clin. Oncol. VL - 25 IS - 5 N2 - The efficacy of neoadjuvant and adjuvant chemotherapy has been clearly established in the treatment of osteosarcoma; however, the most active regimen remains to be identified. This prospective study evaluated the efficacy and toxicity of a dose-intense ifosfamide, doxorubicin, and cisplatin-based neoadjuvant regimen in adults with osteosarcoma. We prospectively treated 20 patients with osteogenic sarcoma with two cycles of ifosfamide/doxorubicin followed by two cycles of doxorubicin/cisplatin every 2 weeks. Surgical specimens were analyzed for percent tumor necrosis. Patients who demonstrated a "good response" (GR) to chemotherapy received the same combination postoperatively at a lower dose rate. Patients who demonstrated a "poor response" (PR) received four cycles of high-dose methotrexate alternating with two cycles of ifosfamide/etoposide and two cycles of cisplatin/etoposide after the surgery. Neoadjuvant chemotherapy was well tolerated with moderate hematologic toxicity. Twelve of 19 evaluable patients (63%) were treated according to the GR arm and 7 according to the PR arm. At median follow-up of 5.5 years, disease-free survival (DFS) and overall survival (OS) are 68% and 74%, respectively. Patients treated on the GR arm had DFS and OS of 75% and 83%, respectively, whereas patients on the PR arm had DFS and OS of 57%. Intensive neoadjuvant chemotherapy is effective and moderately well tolerated in patients with de novo osteosarcoma. The outcome data suggest that lack of a near complete response to preoperative chemotherapy reflects inherent biologic resistance to chemotherapy and hence a poor prognosis. SN - 0277-3732 UR - https://www.unboundmedicine.com/medline/citation/12393991/Dose_intense_ifosfamide/doxorubicin/cisplatin_based_chemotherapy_for_osteosarcoma_in_adults_ L2 - http://dx.doi.org/10.1097/00000421-200210000-00014 DB - PRIME DP - Unbound Medicine ER -