Novel Oncologic Strategies in Osteosarcoma Management: Maximizing Impact, Minimizing Harm

Doxorubicin (DOX), an anthracycline antibiotic, is pivotal in managing osteosarcoma (OS). Although a cornerstone in the multimodal treatment regimen, its usage is limited by its associated toxicities, such as cardiotoxicity, myelosuppression, and neurotoxicity. This review provides an in-depth discussion of the emerging research aimed at enhancing the overall efficacy and mitigating the undesired side effects of DOX in treating OS. We explore the various drug delivery systems, including polymer-based injectable hydrogels, hydroxyapatite-based systems, and various nanoparticle-based systems such as calcium carbonate nanocrystals and cerium-substituted hydroxyapatite. We also discuss various innovative combination therapies, such as pegylated liposomal DOX with cisplatin and DOX with platinum nanoparticles. Moreover, emerging research into light-sensitive nano-micelles have been highlighted. These methods improve DOX's cytotoxicity and potentially reduce the need for high systemic doses and their associated side effects. The review aims to highlight the promising future in OS treatment by integrating these methodologies to maximize the therapeutic action of DOX and reduce its systemic side effects.