Systematic Review of Recurrent Osteosarcoma Systemic Therapy

Area of Science:

• Oncology
• Orthopedic Oncology
• Cancer Research

Background:

• Osteosarcoma is the most common primary bone cancer, predominantly affecting young individuals.
• While current treatments improve cure rates, recurrent and refractory osteosarcoma remain significant therapeutic challenges.

Purpose of the Study:

• To systematically review clinical evidence on treatments for recurrent and/or refractory osteosarcoma over the past two decades.
• To evaluate the efficacy of various therapeutic strategies in managing advanced osteosarcoma.

Main Methods:

• Conducted a systematic literature review of 72 eligible studies published in the last 20 years.
• Included 56 prospective clinical trials, mostly multicentric, single-arm, phase I/II, and non-randomized.
• Analyzed treatments including chemotherapy, targeted agents (tyrosine kinase and mTOR inhibitors), immunotherapy, and combination therapies.

Main Results:

• Most evaluated treatments demonstrated limited objective response rates in recurrent or refractory osteosarcoma.
• Some therapies showed potential for disease control, but significant breakthroughs were not widely observed.
• No specific driver mutations were identified as effective treatment targets, and predictive biomarkers are lacking.

Conclusions:

• Current treatment options for recurrent and refractory osteosarcoma are largely insufficient, highlighting an unmet clinical need.
• The lack of identified driver mutations and predictive biomarkers hinders personalized treatment strategies.
• Future research focusing on underlying biological mechanisms is crucial to develop novel and effective therapies for pre-treated osteosarcoma patients.