The feasibility of neoadjuvant high-dose chemotherapy and autologous peripheral blood stem cell transplantation in patients with nonmetastatic high grade localized osteosarcoma - Results of a phase II study

BACKGROUND. The primary and secondary objectives of the current study were to improve the >= 90% tumor necrosis rate and assess the toxicity profile of the neoadjuvant high-dose chemotherapy (HDC) regimen, respectively. METHODS. Twenty-two patients with AJCC Stage IIB high-grade osteosarcoma were included in the current study. Two cycles of an induction chemotherapy regimen including cisplatin, doxorubicin, and ifosfamide followed by HDC and autologous peripheral blood stem cell support or transplantation (APBSCT) were given. After engraftment was achieved, the patients underwent limb-sparing surgery (LSS) followed by three to six cycles of postoperative chemotherapy depending on the tumor necrosis rate. RESULTS. The median follow-up, the total duration of treatment, and the time to surgery were 23.7 months, 5.96 months, and 3.03 months, respectively. The necrosis rate was at least 90% in 82% of the cases. The 3-year overall survival (OS) and disease-free survival (DFS) rates were 83% and 70%, respectively. Leukopenia, anemia, thrombocytopenia, nausea and emesis, and mucositis were the most frequent Grade 3 and Grade 4 toxicities (according to the National Cancer Institute Common Toxicity Criteria [version 2.0]) of induction, high-dose, and adjuvant chemotherapies. At the time of last follow-up, no patient had died of chemotherapeutic toxicity. LSS was performed in all patients. Surgery-related complications were reported in 3 of 22 patients. Functional scoring results were excellent in eight patients, good in nine patients, fair in two patients, and poor in three patients. CONCLUSIONS. The results of the current Phase 11 study suggest that neoadjuvant HDC provides a greater than 90% necrosis rate with acceptable toxicity. A short duration of therapy and the feasibility of LSS in all patients are additional advantages of this approach.