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High-dose methotrexate in osteogenic sarcoma

N Jaffe, M P Link, D Cohen

    National Cancer Institute Monograph
    |April 1, 1981
    PubMed
    Summary
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    High-dose methotrexate (HDMTX) combined with adjuvant chemotherapy showed promising disease-free survival rates in osteosarcoma patients. Weekly HDMTX regimens were most effective for pulmonary metastases and primary tumors.

    Area of Science:

    • Oncology
    • Pharmacology
    • Clinical Medicine

    Background:

    • Osteosarcoma treatment historically faced challenges with disease recurrence and survival.
    • High-dose methotrexate (HDMTX) has been a cornerstone in osteosarcoma therapy.
    • Adjuvant chemotherapy regimens aim to improve treatment outcomes.

    Purpose of the Study:

    • To evaluate the efficacy of different high-dose methotrexate (HDMTX) adjuvant regimens in osteosarcoma.
    • To compare treatment outcomes with historical control data.
    • To assess the impact of HDMTX administration schedules on survival and response rates.

    Main Methods:

    • Retrospective analysis of osteosarcoma patients treated between 1972-1979.
    • Comparison of three adjuvant regimens: HDMTX alone, HDMTX with adriamycin, and weekly HDMTX combination therapy.

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  • Evaluation of actuarial disease-free survival and response rates in patients with local control and pulmonary metastases.

    • Main Results:

    • Actuarial disease-free survival at 3 years ranged from 42% to 75% with the studied regimens.
    • These results favorably compared to historical controls (50% at 6 months, 20% at 12 months).
    • A weekly HDMTX schedule achieved a 48% response rate in pulmonary metastases and primary tumors for previously untreated patients.

    Conclusions:

    • Adjuvant HDMTX regimens, particularly weekly schedules, demonstrated improved disease-free survival in osteosarcoma.
    • Weekly HDMTX showed significant efficacy in managing pulmonary metastases and primary tumors.
    • Urinary alkalinization did not show a significant impact on HDMTX pharmacokinetics in this study.