IFOSFAMIDE OF LIMITED HELP IN NON METASTATIC OSTEOSARCOMA 

NEW YORK (Reuters Health) Jun 26 - In patients with nonmetastatic osteosarcoma of the extremity, adding ifosamide to neoadjuvant chemotherapy with methotrexate, cisplatin, and doxorubicin does not improve outcomes, Italian researchers have found.

Dr. Stefano Ferrari, the lead author of the new report, told Reuters Health by email that the "probability of survival in patients with non-metastatic osteosarcoma of the extremity has improved dramatically with the addition of chemotherapy to surgical removal of the tumor, but a standard chemotherapy regimen has not yet been defined."

To help do so, Dr. Ferrari of Istituto Ortopedico Rizzoli, Bologna, and colleagues studied 230 patients who underwent limb salvage surgery and had been randomly assigned to receive methotrexate, cisplatin, and doxorubicin with or without ifosfamide. In the latter regimen, ifosfamide was given only postoperatively to patients with poor histologic response to the primary chemotherapy.

Patients not given ifosfamide as part of their primary regimen were treated for up to 44 weeks, while the others received 34 weeks of treatment, according to results published online May 7 in the Journal of Clinical Oncology.

Chemotherapy-induced necrosis was deemed good in 45% of patients with no significant difference between groups. However, three patients in the ifosfamide primary group died of treatment-related toxicity compared to one in the other group.

Hematological toxicity was also greater in the ifosfamide group. This was true of the need for RBC transfusion (78% vs. 35%, p<0.001) and hospitalization (76% vs. 44%, p<0.001). There were similar findings for other related outcomes.

With a median of 66 months of follow-up, 5-year overall survival was no greater in the ifosfamide group (74% vs. 73%). This was also true of event-free survival (55% vs. 64%).

"The study demonstrated that ifosfamide added to methotrexate, cisplatin and doxorubicin from the preoperative phase does not improve the survival and increases haematological toxicity," said Dr. Ferrari.

"Ifosfamide should only be considered in patients who have a poor histological response to methotrexate, cisplatin and doxorubicin."