Neoadjuvant Chemotherapy for Adults with Osteogenic Sarcoma

Area of Science:

• Orthopedic Oncology
• Medical Oncology
• Cancer Therapeutics

Background:

• Osteosarcoma is the most common primary bone cancer in adolescents and adults.
• Current standard of care, methotrexate, doxorubicin, and cisplatin (MAP) chemotherapy with surgery, has not improved survival in 40 years.
• Metastatic osteosarcoma has a poor 5-year survival rate of 10-20%.

Purpose of the Study:

• To review the current neoadjuvant standard of care for osteosarcoma.
• To discuss contemporary therapeutic options beyond MAP chemotherapy.
• To identify challenges and future research directions for osteosarcoma treatment.

Main Methods:

• Review of current neoadjuvant standard of care (MAP chemotherapy and surgery).
• Survey of contemporary therapeutic options: tyrosine kinase inhibitors (TKIs), immune checkpoint inhibitors (ICIs), monoclonal antibodies (mAbs), and chimeric antigen receptor (CAR) T cells.
• Analysis of challenges hindering novel treatment success.

Main Results:

• The efficacy of MAP chemotherapy has plateaued, leading to persistent poor outcomes for 40 years.
• Novel therapeutic strategies, including TKIs, ICIs, mAbs, and CAR T-cells, are under investigation.
• Clinical trials for novel treatments have not yet yielded significant improvements in patient survival.

Conclusions:

• There is a critical need for improved therapeutic strategies to overcome the treatment plateau in osteosarcoma.
• Investigating and overcoming challenges associated with novel therapies is crucial for future progress.
• Further research into targeted therapies and immunotherapies holds potential for advancing osteosarcoma treatment.