VP = Etoposide, 100 mg/m2day x 5 days: 5 courses = Total 2,500 mg/m2 MTX = Methotrexate, 12 g/m2 over 4 hours, plus leucovorin, 15 mg q6h x 10 doses: 10 courses I = Ifosfamide, 2.4 g/m2 + mesna/day x 5 days: 3 courses = Total 36 g/m2. Total ifosfamide A = Doxorubicin, 37.5 mg/m2/day x 2 days: 5 courses = Total 375 mg/m2 P = CDDP, 60 mg/m2/day x 2 days: 4 courses = Total 480 mg/m2 *G = G - CSF 5 |xg/kg/day
Fig. 21-8. Continuation chemotherapy regimen started 1-2 weeks after surgery. (From Goorin AM, Harris MB, Berstein M, Ferguson W, Devidas M, Siegal GP, Gebhardt C, Schwartz CL, Link MP, Grier HE. Phase II/III trial of etoposide and high dose ifosfamide in newly diagnosed metastatic osteosarcoma: a Pediatric Oncology Group trial. J Clin Oncol 2002;20:426-433, with permission.)
Newer Agents under Investigation
Several cooperative groups and institutions have intensified the postoperative treatment to improve the outcome of patients who have a standard response (<90% necrosis) to neoadjuvant chemotherapy. Most of these studies show that the intensified treatment does not change the outcome for these patients. In addition, several institutions have intensified their neoadjuvant treatments to influence this outcome. Although the percentage of good responders increases, the event-free and overall survival rates have not changed. The degree of necrosis to chemotherapy appears to be an innate sensitivity of an osteosarcoma to chemotherapy, which is not altered by intensification of the chemotherapy. For this reason, targeted or biologically based therapies such as liposomal muramyl tripeptide-phosphatidylethanolamine (MTP-PE), interferon, trastuzumab, and granulocyte macrophage colony-stimulating factor are being investigated.
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