Editorial Comment: 2017 Musculoskeletal Tumor Society Proceedings

The 41^st meeting of the Musculoskeletal Tumor Society (MSTS) provided the personal interaction and cross-fertilization of ideas that stimulates progress in our field. Although not all readers of Clinical Orthopaedics and Related Research® treat patients with malignant disease, all of us know patients who have cancer, and if for no other reason than that, we should all be interested in the major themes that were discussed at this meeting. I expect many of the ideas MSTS members heard at this meeting to develop into treatments for our patients with neoplastic conditions, and so they are worth the attention of everyone who reads CORR®.

Presidential guest speaker Nicole Ehrhardt VMD, a veterinary surgeon and leading clinical and basic researcher at Colorado State University, reminded the meeting participants about the analogy between canine and human osteogenic sarcoma. Similarities in terms of disease etiology, progression, and treatments between species has given rise to some important advances, including the use of adjuvant muramyl tripeptide phospho-ethanolamine as an immunologic treatment and first-line therapy for a cancer. Translating this into the next generation of novel therapies, Dr. Ehrhardt showed our attendees how advances in the burgeoning field of immunology can use viral immunization to change the development and progression of osteogenic sarcoma. It is this sort of work that will push the MSTS and the entire discipline of orthopaedic oncology forward.

Treatment of bone metastases continues to evolve as new systemic agents have become available. Targeted and biologic therapies have the potential to increase the expected survival of patients’ bone metastases. Among the cancers that commonly spread to bone, EGFR inhibitors and new trials targeting ALK-, ROS1-, and BRAF V600E are successful in nonsmall cell lung cancers [4]. First-line VEGF-targeted therapy and second-line everolimus are successful in many renal cell carcinoma patients [2]. Estrogen positive, HER-2 positive, and even triple-negative breast cancers are showing responses to new targeted therapies [1, 3, 5].

Standard orthopaedic approaches like prophylactic fixation, rodding, or resection arthroplasty should be reevaluated considering the seemingly vast potential of targeted and biologic treatments. Although I am excited by what I heard, and I believe that in time these approaches indeed will change the way we care for our patients, I found some of the results in this year’s published proceedings in CORR to be sobering. I hope these findings will push us to continue to improve both on the safety and efficacy of the treatments we prescribe.

Although we have not seen much improvement in survivorship for patients with primary bone sarcoma, most patients do survive. For those patients, progress is needed to improve the durability of limb reconstructions. Novel strategies are also needed, but investigator bias, patient variability, and low accrual continue to make it difficult to reach conclusions about new approaches. Randomized trials comparing different implants and reconstructive techniques are sorely needed. In their absence, long-term followup of the existing reconstructions as provided in these proceedings can guide us.

Orthopaedic oncologists are inherently optimistic, and I believe that the scientific and empiric advances reported at the MSTS Annual Meeting captured in these proceedings provide ample cause for optimism. The opportunity to showcase the field’s best work stimulates our membership to answer our most-pressing questions, and to share their results with the extended community. By promoting the search for practical solutions, we encourage the hope that patients, doctors, and families need.

John H. Healey MD, FACS