Results of methotrexate-etoposide-ifosfamide based regimen (M-EI) in osteosarcoma patients included in the French OS2006/sarcome-09 study

• Published in: European journal of cancer (1990) 2018-01, Vol.88, p.57-66
• Main Authors: Gaspar, Nathalie, Occean, Bob-Valéry, Pacquement, Hélène, Bompas, Emmanuelle, Bouvier, Corine, Brisse, Hervé J., Castex, Marie-Pierre, Cheurfa, Nadir, Corradini, Nadège, Delaye, Jessy, Entz-Werlé, Natacha, Gentet, Jean-Claude, Italiano, Antoine, Lervat, Cyril, Marec-Berard, Perrine, Mascard, Eric, Redini, Françoise, Saumet, Laure, Schmitt, Claudine, Tabone, Marie-Dominique, Verite-Goulard, Cécile, Le Deley, Marie-Cécile, Piperno-Neumann, Sophie, Brugieres, Laurence
• Format: Article
• Language: English
• Subjects: Adolescents; Biocompatibility; Biomedical materials; Bone cancer; Cancer; Chemotherapy; Children; Doxorubicin; Etoposide; Hematology; Human health and pathology; Ifosfamide; Life Sciences; Metastases; Methotrexate; Osteosarcoma; Patients; Pediatrics; Randomization; Rhumatology and musculoskeletal system; Risk; Sarcoma; Studies; Surgery; Survival; Toxicity; Tumors; Zoledronic acid
• ISSN: 0959-8049; 1879-0852
• DOI: 10.1016/j.ejca.2017.09.036

In most countries, reference chemotherapy for osteosarcoma is MAP regimen (M = high-dose methotrexate, AP = doxorubicin-cisplatinum). In France, the standard preoperative chemotherapy for children/adolescents combines M and etoposide-ifosfamide (EI), based on the OS94-trial. We report the safety and efficacy results of patients ≤25 years treated with preoperative M-EI regimen enroled in the French OS2006-study, between 2007 and 2014. Treatment comprised preoperative chemotherapy with the 7 M-courses and 2 EI-courses, then surgery and postoperative chemotherapy assigned by risk's groups: standard-risk (good histological response without metastases) received 12 M-courses, 3 EI-courses; high-risk (poor histologic response, initial metastases or unresectable primary) received 5 M-courses alternated with 5 AP-courses. 253 patients were randomised to receive (n = 128) or not (n = 125) zoledronate. 409/522 patients enroled in the OS2006 study who received preoperative M-EI were analysed. Median age was 14.3 years (4.7–24.5), with 55 patients aged 18–25 years. Primary tumour location was limb in 383 patients (94%) and 85 (21%) presented metastases. Median chemotherapy duration was 37.4 weeks. 381 (96%) patients underwent surgery, 258 patients (65%) had a good histologic response. 187/324 patients (58%) with localised disease did not receive doxorubicin nor cisplatinum. Toxicity was evaluated in the randomised study: most patients experienced ≥1 severe toxicity (grade IV haematological or grade III/IV extra-haematological). Median follow-up was 4.8 years, and 168 patients had events. Five-year event-free survival was 56% (95% CI, 51–62%) and overall survival 71% (66–76%). M-EI regimen/strategy was feasible for patient aged ≤25 years with survival rates are comparable to those obtained with MAP regimen. •Paediatric and young adult methotrexate-based chemotherapy regimen of OS2006 protocol.•Event-free survival and overall survival rates were similar to those with standard Methotrexate-Doxorubicin-Cisplatinum (MAP) regimen used worldwide.•First-line treatment with doxorubicin and cisplatinum was avoided in 58% patients with localised tumours.