Table 1.

Relapse Regimens for Osteosarcoma and Ewing Sarcoma

	Agents and Schedule	Primary Toxicities	Cumulative No.	Estimated or Communicated PFS at 4 mo	Median Time to Progression	Combined Response Rate	Partial Response	Complete Response	Toxicitya
Osteosarcoma	Ifosfamide + etoposide: iv, inpatient, d 1‐5 of 21‐d cycle17, 18, 20, 21	Myelosuppression (requires myeloid growth factor), neurotoxicity, alopecia	83	80%	N/A	27%	25%	<5% without surgery	Very high
	Sorafenib: po, bid, continuously22	Rash (hand‐foot skin reaction), hypertension, mucositis	35	46% (mean, 4 mo)	4 mo	9%	9%b	0	Low
	Gemcitabine + docetaxel: iv, outpatient, d 1 and 8 of 21‐d cycle23, 24, 25, 26, 27	Myelosuppression (requires myeloid growth factor), cumulative neurotoxicity, allergic reactions, alopecia	68	40%	4 mo	16%	16%	<5% without surgery	High
Ewing sarcoma	Cyclophosphamide + topotecan: iv, outpatient, d 1‐5 of 21‐d cycle28, 29	Myelosuppression (requires myeloid growth factor), alopecia	71	Early progression: < 25% Late progression: > 75%	N/A	35%	10%	25%	Medium
	Temozolomide + irinotecan ± vincristine: outpatient, po or iv and d 1‐5 for irinotecan, po and d 1‐5 for temozolomide (vincristine on d 1)30, 31	Diarrhea (treated with loperamide and antibiotic pretreatment)	102	55%‐70%	N/A	53%	27%	26%	Medium
	High‐dose ifosfamide: iv, inpatient, d 1‐5 of 21‐d cycle32	Myelosuppression (requires myeloid growth factor), neurotoxicity, alopecia	35	N/A	N/A	34%	29%	5%	Very high
	Gemcitabine + docetaxel: iv, outpatient, d 1 and 8 of 21‐d cycle23, 24, 33	Myelosuppression (requires myeloid growth factor), cumulative neurotoxicity, allergic reaction, alopecia	24	>25%	5 mo	29%	25%	<5% without radiation	High
	Oral etoposide: po, daily for several weeks on, 1‐ to 2‐wk break as tolerated34	Myelosuppression, secondary malignancy	58	33%	N/A	19%	19%	<5%	Low

Abbreviations: bid, twice daily; iv, intravenous; N/A, not available; PFS, progression‐free survival; po, by mouth; d, day.

^aVery high, high, medium, or low.

^bResponse Evaluation Criteria in Solid Tumors.