High-dose chemotherapy with stem cell rescue in the primary treatment of metastatic and pelvic osteosarcoma: Final results of the ISG/SSG II study

Kjetil Boye, Adalberto Brach Del Prever, Mikael Eriksson, Gunnar Sæter, Amelia Tienghi, Paula Lindholm, Franca Fagioli, Sigmund Skjeldal, Stefano Ferrari, Kirsten Sundby Hall

Research output: Contribution to journalArticle

20 Citations (Scopus)

Abstract

Background: Patients with metastatic osteosarcoma at diagnosis or axial primary tumors have a poor prognosis. The aim of the study was to evaluate the feasibility and efficacy of intensified treatment with high-dose chemotherapy (HDCT) and stem cell rescue in this group. Methods: From May 1996 to August 2004, 71 patients were included in a Scandinavian-Italian single arm phase II study. Preoperative chemotherapy included methotrexate, doxorubicin, cisplatin and ifosfamide, and postoperative treatment consisted of two cycles of doxorubicin, one cycle of cyclophosphamide and etoposide and two courses of high-dose etoposide and carboplatin with stem cell rescue. Results: Twenty-nine patients (43%) received two courses and 10 patients (15%) received one course of HDCT. HDCT was associated with significant toxicity, but no treatment-related deaths were recorded. Fourteen patients (20%) had disease progression before completion of the study protocol, and only 29/71 patients (41%) received the full planned treatment. Median event-free survival (EFS) was 18 months, and estimated 5-year EFS was 27%. Median overall survival (OS) was 34 months, and estimated 5-year OS was 31%. When patients who did not receive HDCT due to disease progression were excluded, there was no difference in EFS (P=0.72) or OS (P=0.49) between patients who did or did not receive HDCT. Conclusions: The administration of high-dose chemotherapy with stem cell rescue was feasible, but associated with significant toxicity. Patient outcome seemed comparable to previous studies using conventional chemotherapy. We conclude that HDCT with carboplatin and etoposide should not be further explored as a treatment strategy in high-risk osteosarcoma. Pediatr Blood Cancer 2014;61:840-845.

Original languageEnglish
Pages (from-to)840-845
Number of pages6
JournalPediatric Blood and Cancer
Volume61
Issue number5
DOIs
Publication statusPublished - 2014

Fingerprint

Osteosarcoma
Stem Cells
Drug Therapy
Etoposide
Disease-Free Survival
Therapeutics
Carboplatin
Doxorubicin
Survival
Disease Progression
Ifosfamide
Methotrexate
Cyclophosphamide
Cisplatin
Neoplasms

Keywords

  • High-dose chemotherapy
  • Metastasis
  • Osteosarcoma
  • Pelvic primary tumor
  • Stem cell rescue

ASJC Scopus subject areas

  • Oncology
  • Pediatrics, Perinatology, and Child Health
  • Hematology

Cite this

High-dose chemotherapy with stem cell rescue in the primary treatment of metastatic and pelvic osteosarcoma : Final results of the ISG/SSG II study. / Boye, Kjetil; Del Prever, Adalberto Brach; Eriksson, Mikael; Sæter, Gunnar; Tienghi, Amelia; Lindholm, Paula; Fagioli, Franca; Skjeldal, Sigmund; Ferrari, Stefano; Hall, Kirsten Sundby.

In: Pediatric Blood and Cancer, Vol. 61, No. 5, 2014, p. 840-845.

Research output: Contribution to journalArticle

Boye, K, Del Prever, AB, Eriksson, M, Sæter, G, Tienghi, A, Lindholm, P, Fagioli, F, Skjeldal, S, Ferrari, S & Hall, KS 2014, 'High-dose chemotherapy with stem cell rescue in the primary treatment of metastatic and pelvic osteosarcoma: Final results of the ISG/SSG II study', Pediatric Blood and Cancer, vol. 61, no. 5, pp. 840-845. https://doi.org/10.1002/pbc.24868
Boye, Kjetil ; Del Prever, Adalberto Brach ; Eriksson, Mikael ; Sæter, Gunnar ; Tienghi, Amelia ; Lindholm, Paula ; Fagioli, Franca ; Skjeldal, Sigmund ; Ferrari, Stefano ; Hall, Kirsten Sundby. / High-dose chemotherapy with stem cell rescue in the primary treatment of metastatic and pelvic osteosarcoma : Final results of the ISG/SSG II study. In: Pediatric Blood and Cancer. 2014 ; Vol. 61, No. 5. pp. 840-845.
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abstract = "Background: Patients with metastatic osteosarcoma at diagnosis or axial primary tumors have a poor prognosis. The aim of the study was to evaluate the feasibility and efficacy of intensified treatment with high-dose chemotherapy (HDCT) and stem cell rescue in this group. Methods: From May 1996 to August 2004, 71 patients were included in a Scandinavian-Italian single arm phase II study. Preoperative chemotherapy included methotrexate, doxorubicin, cisplatin and ifosfamide, and postoperative treatment consisted of two cycles of doxorubicin, one cycle of cyclophosphamide and etoposide and two courses of high-dose etoposide and carboplatin with stem cell rescue. Results: Twenty-nine patients (43{\%}) received two courses and 10 patients (15{\%}) received one course of HDCT. HDCT was associated with significant toxicity, but no treatment-related deaths were recorded. Fourteen patients (20{\%}) had disease progression before completion of the study protocol, and only 29/71 patients (41{\%}) received the full planned treatment. Median event-free survival (EFS) was 18 months, and estimated 5-year EFS was 27{\%}. Median overall survival (OS) was 34 months, and estimated 5-year OS was 31{\%}. When patients who did not receive HDCT due to disease progression were excluded, there was no difference in EFS (P=0.72) or OS (P=0.49) between patients who did or did not receive HDCT. Conclusions: The administration of high-dose chemotherapy with stem cell rescue was feasible, but associated with significant toxicity. Patient outcome seemed comparable to previous studies using conventional chemotherapy. We conclude that HDCT with carboplatin and etoposide should not be further explored as a treatment strategy in high-risk osteosarcoma. Pediatr Blood Cancer 2014;61:840-845.",
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T1 - High-dose chemotherapy with stem cell rescue in the primary treatment of metastatic and pelvic osteosarcoma

T2 - Final results of the ISG/SSG II study

AU - Boye, Kjetil

AU - Del Prever, Adalberto Brach

AU - Eriksson, Mikael

AU - Sæter, Gunnar

AU - Tienghi, Amelia

AU - Lindholm, Paula

AU - Fagioli, Franca

AU - Skjeldal, Sigmund

AU - Ferrari, Stefano

AU - Hall, Kirsten Sundby

PY - 2014

Y1 - 2014

N2 - Background: Patients with metastatic osteosarcoma at diagnosis or axial primary tumors have a poor prognosis. The aim of the study was to evaluate the feasibility and efficacy of intensified treatment with high-dose chemotherapy (HDCT) and stem cell rescue in this group. Methods: From May 1996 to August 2004, 71 patients were included in a Scandinavian-Italian single arm phase II study. Preoperative chemotherapy included methotrexate, doxorubicin, cisplatin and ifosfamide, and postoperative treatment consisted of two cycles of doxorubicin, one cycle of cyclophosphamide and etoposide and two courses of high-dose etoposide and carboplatin with stem cell rescue. Results: Twenty-nine patients (43%) received two courses and 10 patients (15%) received one course of HDCT. HDCT was associated with significant toxicity, but no treatment-related deaths were recorded. Fourteen patients (20%) had disease progression before completion of the study protocol, and only 29/71 patients (41%) received the full planned treatment. Median event-free survival (EFS) was 18 months, and estimated 5-year EFS was 27%. Median overall survival (OS) was 34 months, and estimated 5-year OS was 31%. When patients who did not receive HDCT due to disease progression were excluded, there was no difference in EFS (P=0.72) or OS (P=0.49) between patients who did or did not receive HDCT. Conclusions: The administration of high-dose chemotherapy with stem cell rescue was feasible, but associated with significant toxicity. Patient outcome seemed comparable to previous studies using conventional chemotherapy. We conclude that HDCT with carboplatin and etoposide should not be further explored as a treatment strategy in high-risk osteosarcoma. Pediatr Blood Cancer 2014;61:840-845.

AB - Background: Patients with metastatic osteosarcoma at diagnosis or axial primary tumors have a poor prognosis. The aim of the study was to evaluate the feasibility and efficacy of intensified treatment with high-dose chemotherapy (HDCT) and stem cell rescue in this group. Methods: From May 1996 to August 2004, 71 patients were included in a Scandinavian-Italian single arm phase II study. Preoperative chemotherapy included methotrexate, doxorubicin, cisplatin and ifosfamide, and postoperative treatment consisted of two cycles of doxorubicin, one cycle of cyclophosphamide and etoposide and two courses of high-dose etoposide and carboplatin with stem cell rescue. Results: Twenty-nine patients (43%) received two courses and 10 patients (15%) received one course of HDCT. HDCT was associated with significant toxicity, but no treatment-related deaths were recorded. Fourteen patients (20%) had disease progression before completion of the study protocol, and only 29/71 patients (41%) received the full planned treatment. Median event-free survival (EFS) was 18 months, and estimated 5-year EFS was 27%. Median overall survival (OS) was 34 months, and estimated 5-year OS was 31%. When patients who did not receive HDCT due to disease progression were excluded, there was no difference in EFS (P=0.72) or OS (P=0.49) between patients who did or did not receive HDCT. Conclusions: The administration of high-dose chemotherapy with stem cell rescue was feasible, but associated with significant toxicity. Patient outcome seemed comparable to previous studies using conventional chemotherapy. We conclude that HDCT with carboplatin and etoposide should not be further explored as a treatment strategy in high-risk osteosarcoma. Pediatr Blood Cancer 2014;61:840-845.

KW - High-dose chemotherapy

KW - Metastasis

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KW - Pelvic primary tumor

KW - Stem cell rescue

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