Table 7.
Indian studies evaluating chemotherapy protocols and outcomes is metastatic osteosarcoma
| Study details | No. of patients of metastatic OS | Protocol used | Site of metastasis | Surgery | Outcomes and factors predicting survival | Toxicity (grade 3/4) |
|---|---|---|---|---|---|---|
| Bajpai et al, JGO, 2018 [92] | 80 |
OGS 12 4# NACT and 4# ACT, removed etoposide The cumulative doses were CDDP 600 mg/m2 , Dox 300 mg/m2, and Ifo 54 g/m2 |
83% lung metastasis, 44% bilateral, 3% bone only metastasis | 69 patients underwent surgery, 50 limb salvage and 40 metastasectomy |
GR—57% 4-year EFS—24% 4-year OS—27% Median f/up—32 months |
FN—51% Anemia—54% Thrombocytopenia—36% |
| Nataraj et al, Clinical and Translational Oncology, 2016 31 | 102 |
3# NACT—AP ACT IE alternate with AP (6#) Cumulative dose of A—450mg/m2 P—720mg/m2 I—15g/m2 |
67.6% lung only metastasis, 22.5% both lung and bone, 9% bone only | 56—local site surgery, limb salvage 50%, delayed metastasectomy at end of ACT in 5 patients who did not progress or did not have CR at lung lesion |
5-year EFS—12.7% 5-year OS—28.1% Median F/up—23 months |
Total—31.4% Neutropenia—20.6% Thrombocytopenia—3.9% Mucositis—3.9% Toxic deaths—3 (2.9%) |
| Ramanujan et al, Indian Journal of Cancer, 2020 [102] | 37 | IAP | Synchronous or metachronous resectable lung metastasis in all | Delayed metastasectomy after completion of chemotherapy in all patients, 22% needed two procedures |
GR—23% Median OS—38 ± 2.7 months Median post-metastasis survival was 23 ± 5.7 months 2-, 3-, and 5-year OS were 86 ± 5.8%, 60.8 ± 8.6%, and 20.7 ± 7.4%, respectively Completion of systemic chemotherapy, disease-free interval (DFI) of >2 years, and absence of pulmonary recurrence postmetastasectomy were predictors of survival |
|
| Pramanik et al, JAMA Oncology, 2018 [95] | 72 (bone sarcomas), progressive after at least 2 lines of chemotherapy | Thalidomide, celecoxib, etoposide, cyclophosphamide |
No benefit of oral metronomic therapy, 100% vs 94.6% progression at 6 months in placebo vs OMT group Median PFS—48 days; median OS—80 days |
JAMA Journal of American Medical Association, JGO Journal of Global Oncology, A adriamycin, P cisplatin, I ifosfamide, E etoposide, DFS disease-free survival, EFS event-free survival, OS overall survival, GR good response, PR poor response, NACT neoadjuvant chemotherapy, ACT adjuvant chemotherapy, FN febrile neutropenia, PS performance status, DFI disease-free interval, OMT oral metronomic therapy