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Moisan R, Leroy X, Fron D, Leblond P, Lervat C. Uncommon metachronous multiple sites recurrences of metastatic osteosarcoma cured by surgery: a case report. Acta Oncol 2023; 62:1106-1109. [PMID: 37577764 DOI: 10.1080/0284186x.2023.2245966] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2023] [Accepted: 08/03/2023] [Indexed: 08/15/2023]
Affiliation(s)
- Rafaël Moisan
- Pediatrics and AYA Oncology Department, Centre Oscar Lambret, Lille, France
| | - Xavier Leroy
- Anatomopathology Department, Universitary Hospital Center, Lille, France
| | - Damien Fron
- Pediatric Orthopedic Surgery Department, Universitary Hospital Center, Lille, France
| | - Pierre Leblond
- Pediatric Oncology Department, Centre Léon Bérard IHOPE, Centre Léon Bérard, Lyon, France
| | - Cyril Lervat
- Pediatrics and AYA Oncology Department, Centre Oscar Lambret, Lille, France
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Mettmann VL, Baumhoer D, Bielack SS, Blattmann C, Friedel G, von Kalle T, Kager L, Kevric M, Nathrath M, Sorg B, Dürken M, Hecker‐Nolting S. Solitary pulmonary metastases at first recurrence of osteosarcoma: Presentation, treatment, and survival of 219 patients of the Cooperative Osteosarcoma Study Group. Cancer Med 2023; 12:18219-18234. [PMID: 37548393 PMCID: PMC10524021 DOI: 10.1002/cam4.6409] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Revised: 07/04/2023] [Accepted: 07/25/2023] [Indexed: 08/08/2023] Open
Abstract
BACKGROUND To evaluate patient and tumour characteristics, treatment and their impact on survival in patients with a solitary pulmonary metastasis at first relapse of high-grade osteosarcoma. PROCEDURE Two-hundred and nineteen consecutive patients who had achieved a complete surgical remission and then developed a solitary pulmonary metastasis at first recurrence of high-grade osteosarcoma were retrospectively reviewed. RESULTS Two hundred and three (94.9%) of 214 patients achieved a second complete remission. After a median time from initial diagnosis of osteosarcoma to first relapse of 2.3 years (range, 0.3-18.8 years), actuarial post-relapse overall survival after 2 and 5 years was 72.0% and 51.2%. Post-relapse event-free survival was 39.1% and 31.1%. Median follow-up time was 3.2 years (range, 0.1-29.4 years). A longer time until first relapse and diagnosis due to imaging were positive prognostic factors in uni- and multivariate analyses, as were a second complete surgical remission and, in regard to death, the absence of a subsequent relapse. The use of salvage chemotherapy and radiotherapy were not associated with patient outcomes, nor was the surgical approach (thoracoscopy vs. thoracotomy) nor the exploration (uni- vs. bilateral). CONCLUSION Approximately half of the patients who experience a solitary pulmonary relapse at first recurrence of osteosarcoma remain alive 5 years after this first relapse. Only one third will remain disease-free. A complete surgical resection of the lesion is essential for long-term survival while relapse chemotherapy does not seem to improve survival. Innovative therapies are required to improve outcomes.
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Affiliation(s)
- Vanessa L. Mettmann
- Klinikum Stuttgart ‐ Olgahospital, Stuttgart Cancer Centre, Paediatrics 5 (Oncology, Haematology, Immunology)StuttgartGermany
- Medical Faculty HeidelbergHeidelberg UniversityHeidelbergGermany
| | - Daniel Baumhoer
- Bone Tumour Reference Centre, Institute of Medical Genetics and PathologyUniversity Hospital Basel and University of BaselBaselSwitzerland
| | - Stefan S. Bielack
- Klinikum Stuttgart ‐ Olgahospital, Stuttgart Cancer Centre, Paediatrics 5 (Oncology, Haematology, Immunology)StuttgartGermany
- Department for Paediatric Haematology and OncologyUniversity's Children's Hospital MuensterMuensterGermany
| | - Claudia Blattmann
- Klinikum Stuttgart ‐ Olgahospital, Stuttgart Cancer Centre, Paediatrics 5 (Oncology, Haematology, Immunology)StuttgartGermany
| | - Godehard Friedel
- Department of Thoracic SurgeryUniversity of Tubingen, Faculty of ScienceTubingenGermany
| | - Thekla von Kalle
- Klinikum Stuttgart ‐ Olgahospital, Stuttgart Cancer CentreInstitute of RadiologyStuttgartGermany
| | - Leo Kager
- St. Anna KinderspitalUniversity Hospital for Paediatric and Adolescent Medicine of the Medical University, and St. Anna Children's Cancer Research Institute (CCRI)ViennaAustria
| | - Matthias Kevric
- Klinikum Stuttgart ‐ Olgahospital, Stuttgart Cancer Centre, Paediatrics 5 (Oncology, Haematology, Immunology)StuttgartGermany
| | - Michaela Nathrath
- Department of Paediatrics and Children's Cancer Research Centre, Klinikum rechts der IsarTechnical University of Munich, School of MedicineMunichGermany
- Paediatric Haematology and Oncology, Klinikum KasselKasselGermany
| | - Benjamin Sorg
- Klinikum Stuttgart ‐ Olgahospital, Stuttgart Cancer Centre, Paediatrics 5 (Oncology, Haematology, Immunology)StuttgartGermany
| | - Matthias Dürken
- Department of Paediatric Haematology and OncologyMannheim University HospitalMannheimGermany
| | - Stefanie Hecker‐Nolting
- Klinikum Stuttgart ‐ Olgahospital, Stuttgart Cancer Centre, Paediatrics 5 (Oncology, Haematology, Immunology)StuttgartGermany
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Kang SH, Kim W, Lee JS, Suh JK, Kim H, Kim DK, Choi SH, Cho HW, Ju HY, Yoo KH, Sung KW, Koo HH, Seo SW, Im HJ, Lee JW, Koh KN. High-dose chemotherapy followed by autologous stem cell transplantation in pediatric patients with relapsed osteosarcoma. Pediatr Blood Cancer 2023; 70:e30233. [PMID: 36751119 DOI: 10.1002/pbc.30233] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2022] [Revised: 01/02/2023] [Accepted: 01/09/2023] [Indexed: 02/09/2023]
Abstract
BACKGROUND Patients with relapsed osteosarcoma have poor treatment outcomes. High-dose chemotherapy with autologous stem cell transplantation (HDCT/ASCT) has been used in several high-risk malignant solid tumors; however, few studies have evaluated their role in treating osteosarcoma. We evaluated the effectiveness of HDCT/ASCT in relapsed pediatric osteosarcoma cases. PROCEDURE We retrospectively reviewed the medical records of 40 patients diagnosed with and treated for relapsed osteosarcoma at Asan Medical Center and Samsung Medical Center from January 1996 to July 2019. RESULTS The median age of this cohort was 13.4 years (range: 6.1-18.2). The cohort's 5-year overall survival (OS) was 51.0% ± 0.1% during a median follow-up period of 67.5 months. Twenty-five patients (62.5%) achieved complete remission (CR) with salvage treatment, and the 5-year OS was 82.4% ± 0.1%, whereas none of the remaining 15 patients who did not achieve CR survived (p < .0001). Of the 25 CR cases, 15 underwent subsequent HDCT/ASCT. We compared the effect of HDCT/ASCT among patients who achieved CR. There were no significant differences in the 5-year OS outcomes between patients who did and did not receive HDCT/ASCT (83.9% ± 0.1%, 13/15 vs. 80.0% ± 0.1%, 8/10, respectively; p = .923). CONCLUSION To our knowledge, we report the first comparative cohort study that proved HDCT/ASCT does not significantly improve survival outcomes in relapsed osteosarcoma. Achievement of CR remains the most crucial factor for good survival outcomes.
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Affiliation(s)
- Sung Han Kang
- Division of Pediatric Hematology-Oncology, Department of Pediatrics, Asan Medical Center Children's Hospital, University of Ulsan College of Medicine, Seoul, Korea
| | - Wanlim Kim
- Department of Orthopedic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Jong Seok Lee
- Department of Orthopedic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Jin Kyung Suh
- Division of Pediatric Hematology-Oncology, Department of Pediatrics, Korea Cancer Center Hospital, Korea Institute of Radiological & Medical Sciences, Seoul, Korea
| | - Hyery Kim
- Division of Pediatric Hematology-Oncology, Department of Pediatrics, Asan Medical Center Children's Hospital, University of Ulsan College of Medicine, Seoul, Korea
| | - Dong Kwan Kim
- Department of Thoracic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Se Hoon Choi
- Department of Thoracic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Hee Won Cho
- Division of Pediatric Hematology-Oncology, Department of Pediatrics, Samsung Medical Center, University of Sungkyunkwan School of Medicine, Seoul, Korea
| | - Hee Young Ju
- Division of Pediatric Hematology-Oncology, Department of Pediatrics, Samsung Medical Center, University of Sungkyunkwan School of Medicine, Seoul, Korea
| | - Keon Hee Yoo
- Division of Pediatric Hematology-Oncology, Department of Pediatrics, Samsung Medical Center, University of Sungkyunkwan School of Medicine, Seoul, Korea
| | - Ki Woong Sung
- Division of Pediatric Hematology-Oncology, Department of Pediatrics, Samsung Medical Center, University of Sungkyunkwan School of Medicine, Seoul, Korea
| | - Hong Hoe Koo
- Division of Pediatric Hematology-Oncology, Department of Pediatrics, Samsung Medical Center, University of Sungkyunkwan School of Medicine, Seoul, Korea
| | - Sung Wook Seo
- Department of Orthopedic Surgery, Samsung Medical Center, University of Sungkyunkwan School of Medicine, Seoul, Korea
| | - Ho Joon Im
- Division of Pediatric Hematology-Oncology, Department of Pediatrics, Asan Medical Center Children's Hospital, University of Ulsan College of Medicine, Seoul, Korea
| | - Ji Won Lee
- Division of Pediatric Hematology-Oncology, Department of Pediatrics, Samsung Medical Center, University of Sungkyunkwan School of Medicine, Seoul, Korea
| | - Kyung-Nam Koh
- Division of Pediatric Hematology-Oncology, Department of Pediatrics, Asan Medical Center Children's Hospital, University of Ulsan College of Medicine, Seoul, Korea
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4
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Haney SL, Feng D, Chhonker YS, Varney ML, Williams JT, Smith LM, Ford JB, Murry DJ, Holstein SA. Evaluation of geranylgeranyl diphosphate synthase inhibition as a novel strategy for the treatment of osteosarcoma and Ewing sarcoma. Drug Dev Res 2023; 84:62-74. [PMID: 36433690 PMCID: PMC9931648 DOI: 10.1002/ddr.22012] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2022] [Revised: 11/01/2022] [Accepted: 11/03/2022] [Indexed: 11/27/2022]
Abstract
Rab GTPases are critical regulators of protein trafficking in the cell. To ensure proper cellular localization and function, Rab proteins must undergo a posttranslational modification, termed geranylgeranylation. In the isoprenoid biosynthesis pathway, the enzyme geranylgeranyl diphosphate synthase (GGDPS) generates the 20-carbon isoprenoid donor (geranylgeranyl pyrophosphate [GGPP]), which is utilized in the prenylation of Rab proteins. We have pursued the development of GGDPS inhibitors (GGSI) as a novel means to target Rab activity in cancer cells. Osteosarcoma (OS) and Ewing sarcoma (ES) are aggressive childhood bone cancers with stagnant survival statistics and limited treatment options. Here we show that GGSI treatment induces markers of the unfolded protein response (UPR) and triggers apoptotic cell death in a variety of OS and ES cell lines. Confirmation that these effects were secondary to cellular depletion of GGPP and disruption of Rab geranylgeranylation was confirmed via experiments using exogenous GGPP or specific geranylgeranyl transferase inhibitors. Furthermore, GGSI treatment disrupts cellular migration and invasion in vitro. Metabolomic profiles of OS and ES cell lines identify distinct changes in purine metabolism in GGSI-treated cells. Lastly, we demonstrate that GGSI treatment slows tumor growth in a mouse model of ES. Collectively, these studies support further development of GGSIs as a novel treatment for OS and ES.
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Affiliation(s)
- Staci L. Haney
- Department of Internal Medicine, University of Nebraska Medical Center, Omaha, NE
| | - Dan Feng
- Department of Internal Medicine, University of Nebraska Medical Center, Omaha, NE
| | - Yashpal S. Chhonker
- Department of Pharmacy Practice and Science, University of Nebraska Medical Center, Omaha, NE
| | - Michelle L. Varney
- Department of Internal Medicine, University of Nebraska Medical Center, Omaha, NE
| | - Jacob T. Williams
- Department of Internal Medicine, University of Nebraska Medical Center, Omaha, NE
| | - Lynette M. Smith
- Department of Biostatistics, University of Nebraska Medical Center, Omaha, NE
| | - James B. Ford
- Department of Pediatrics, University of Nebraska Medical Center, Omaha, NE
| | - Daryl J. Murry
- Department of Pharmacy Practice and Science, University of Nebraska Medical Center, Omaha, NE
| | - Sarah A. Holstein
- Department of Internal Medicine, University of Nebraska Medical Center, Omaha, NE
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5
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Freeman FE, Burdis R, Mahon OR, Kelly DJ, Artzi N. A Spheroid Model of Early and Late-Stage Osteosarcoma Mimicking the Divergent Relationship between Tumor Elimination and Bone Regeneration. Adv Healthc Mater 2022; 11:e2101296. [PMID: 34636176 DOI: 10.1002/adhm.202101296] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Revised: 10/05/2021] [Indexed: 01/07/2023]
Abstract
Osteosarcoma is the most diagnosed bone tumor in children. The use of tissue engineering strategies after malignant tumor resection remains a subject of scientific controversy. As a result, there is limited research that focuses on bone regeneration postresection, which is further compromised following chemotherapy. This study aims to develop the first co-culture spheroid model for osteosarcoma, to understand the divergent relationship between tumor elimination and bone regeneration. By manipulating the ratio of stromal to osteosarcoma cells the modelled cancer state (early/late) is modified, as is evident by the increased tumor growth rates and an upregulation of a panel of well-established osteosarcoma prognostic genes. Validation of the authors' model is conducted by analyzing its ability to mimic the cytotoxic effects of the FDA-approved chemotherapeutic Doxorubicin. Next, the model is used to investigate what effect osteogenic supplements have, if any, on tumor growth. When their model is treated with osteogenic supplements, there is a stimulatory effect on the surrounding stromal cells. However, when treated with chemotherapeutics this stimulatory effect is significantly diminished. Together, the results of this study present a novel multicellular model of osteosarcoma and provide a unique platform for screening potential therapeutic options for osteosarcoma before conducting in vivo experiments.
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Affiliation(s)
- Fiona E. Freeman
- Trinity Centre for Biomedical Engineering Trinity Biomedical Sciences Institute Trinity College Dublin Dublin D02 R590 Ireland
- Department of Mechanical Manufacturing, and Biomedical Engineering School of Engineering Trinity College Dublin Parsons Building Dublin Dublin 2 Ireland
- Institute for Medical Engineering and Science Massachusetts Institute of Technology Cambridge MA 02142 USA
- Department of Medicine Division of Engineering in Medicine Brigham and Women's Hospital Harvard Medical School Boston MA 02115 USA
| | - Ross Burdis
- Trinity Centre for Biomedical Engineering Trinity Biomedical Sciences Institute Trinity College Dublin Dublin D02 R590 Ireland
- Department of Mechanical Manufacturing, and Biomedical Engineering School of Engineering Trinity College Dublin Parsons Building Dublin Dublin 2 Ireland
- Advanced Materials and Bioengineering Research Centre (AMBER) Royal College of Surgeons in Ireland and Trinity College Dublin Dublin D02 W085 Ireland
| | - Olwyn R. Mahon
- Trinity Centre for Biomedical Engineering Trinity Biomedical Sciences Institute Trinity College Dublin Dublin D02 R590 Ireland
- Health Research Institute and the Bernal Institute University of Limerick Limerick V94 T9PX Ireland
| | - Daniel J. Kelly
- Trinity Centre for Biomedical Engineering Trinity Biomedical Sciences Institute Trinity College Dublin Dublin D02 R590 Ireland
- Department of Mechanical Manufacturing, and Biomedical Engineering School of Engineering Trinity College Dublin Parsons Building Dublin Dublin 2 Ireland
- Advanced Materials and Bioengineering Research Centre (AMBER) Royal College of Surgeons in Ireland and Trinity College Dublin Dublin D02 W085 Ireland
- Department of Anatomy Royal College of Surgeons in Ireland Dublin D02 VN51 Ireland
| | - Natalie Artzi
- Institute for Medical Engineering and Science Massachusetts Institute of Technology Cambridge MA 02142 USA
- Department of Medicine Division of Engineering in Medicine Brigham and Women's Hospital Harvard Medical School Boston MA 02115 USA
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6
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The addition of the immunomodulator mifamurtide to adjuvant chemotherapy for early osteosarcoma: a retrospective analysis. Invest New Drugs 2022; 40:668-675. [DOI: 10.1007/s10637-022-01225-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2022] [Accepted: 02/16/2022] [Indexed: 12/25/2022]
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Cyphert EL, Kanagasegar N, Zhang N, Learn GD, von Recum HA. PMMA Bone Cement Composite Functions as an Adjuvant Chemotherapeutic Platform for Localized and Multi-Window Release During Bone Reconstruction. Macromol Biosci 2022; 22:e2100415. [PMID: 35113499 DOI: 10.1002/mabi.202100415] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2021] [Revised: 01/06/2022] [Indexed: 11/10/2022]
Abstract
Primary bone tumor resections often result in critical size defects, which then necessitate challenging clinical management approaches to reconstruct. One such intervention is the Masquelet technique, in which poly(methyl methacrylate) (PMMA) bone cement is placed as a spacer temporarily while adjuvant chemotherapeutics are administered systemically. The spacer is later removed and replaced with bone autograft. Local recurrence remains an important and devastating problem, therefore, a system capable of locally delivering chemotherapeutics would present unique advantages. In this work, a refillable chemotherapeutic (doxorubicin, DOX) delivery platform comprised of PMMA bone cement and insoluble γ-cyclodextrin (γ-CD) polymeric microparticles is developed and explored towards application as a temporary adjuvant chemotherapeutic spacer. The system is characterized for porosity, mechanical strength, DOX filling and refilling capacity, elution kinetics, and cytotoxicity. Since residual chemotherapeutics could adversely impact bone healing, it is important that virtually all DOX be released from material. Composites containing 15wt% γ-CD microparticles demonstrate 100% DOX release within 100 days, whereas only 6% DOX is liberated from PMMA with free DOX over same period. Refillable properties of PMMA composite system may find utility for customizing dosing regimens. Findings suggest that PMMA composites could have potential as chemotherapeutic delivery platforms to assist in bone reconstruction. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Erika L Cyphert
- Department of Biomedical Engineering, Case Western Reserve University, 10900 Euclid Avenue, Cleveland, OH, 44106, USA
| | - Nithya Kanagasegar
- School of Medicine, Case Western Reserve University, 10900 Euclid Avenue, Cleveland, OH, 44106, USA
| | - Ningjing Zhang
- Department of Biomedical Engineering, Case Western Reserve University, 10900 Euclid Avenue, Cleveland, OH, 44106, USA
| | - Greg D Learn
- Department of Biomedical Engineering, Case Western Reserve University, 10900 Euclid Avenue, Cleveland, OH, 44106, USA
| | - Horst A von Recum
- Department of Biomedical Engineering, Case Western Reserve University, 10900 Euclid Avenue, Cleveland, OH, 44106, USA
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Martinez T, Sarda S, Dupret-Bories A, Charvillat C, Projetti F, Drouet C. Toward a doxorubicin-loaded bioinspired bone cement for the localized treatment of osteosarcoma. Future Oncol 2021; 17:3511-3528. [PMID: 34213375 DOI: 10.2217/fon-2021-0128] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Aims: Osteosarcoma represents the second most common cause of death in children and young adults. No biomaterial allowing local drug delivery has been specifically developed. However, a biocompatible bioactive implantable material could prevent some amputations, and the local release of an antitumor agent could limit risks of relapse and metastasis. Methods: We propose a proof of concept of a self-setting paste combining amorphous calcium phosphate and doxorubicin-loaded particles of bone-like carbonated nanocrystalline apatite, as a means of local release. Results: The cement formulation and doping, first with folic acid and then with doxorubicin, was successful. Its physicochemistry was scrutinized. Preliminary in vivo data on an invasive osteosarcoma rat model suggest a limiting effect on metastatic events in the lungs without signs of toxicity.
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Affiliation(s)
- Thomas Martinez
- CIRIMAT, Université de Toulouse, CNRS, Université Toulouse 3 Paul Sabatier, ENSIACET, Toulouse, 31030, France
| | - Stéphanie Sarda
- CIRIMAT, Université de Toulouse, CNRS, Université Toulouse 3 Paul Sabatier, ENSIACET, Toulouse, 31030, France
| | | | - Cédric Charvillat
- CIRIMAT, Université de Toulouse, CNRS, Université Toulouse 3 Paul Sabatier, ENSIACET, Toulouse, 31030, France
| | | | - Christophe Drouet
- CIRIMAT, Université de Toulouse, CNRS, Université Toulouse 3 Paul Sabatier, ENSIACET, Toulouse, 31030, France
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Gaspar N, Campbell-Hewson Q, Huang J, Okpara CE, Bautista F. OLIE, ITCC-082: a Phase II trial of lenvatinib plus ifosfamide and etoposide in relapsed/refractory osteosarcoma. Future Oncol 2021; 17:4249-4261. [PMID: 34382412 DOI: 10.2217/fon-2021-0743] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
While survival rates for patients with relapsed/refractory osteosarcoma are low, kinase inhibitors have shown efficacy in its treatment. The multikinase inhibitor lenvatinib, plus ifosfamide and etoposide, showed antitumor activity in a Phase II study in patients with relapsed/refractory osteosarcoma. This Phase II randomized controlled trial (OLIE) will assess whether the combination of lenvatinib + ifosfamide + etoposide is superior to ifosfamide + etoposide alone in children, adolescents and young adults with relapsed/refractory osteosarcoma. The primary end point is progression-free survival; secondary and exploratory end points include, but are not limited to, overall survival, objective response rate, safety and tolerability, pharmacokinetic characterization of lenvatinib in the combination treatment, quality of life and quantification of baseline unresectable lesions that are converted to resectable.
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Affiliation(s)
- Nathalie Gaspar
- Department of Childhood & Adolescent Oncology, Gustave Roussy Cancer Campus, Villejuif, France
| | | | - Jie Huang
- Biostatistics, Eisai Inc., Woodcliff Lake, NJ 07677, USA
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Meazza C, Asaftei SD. State-of-the-art, approved therapeutics for the pharmacological management of osteosarcoma. Expert Opin Pharmacother 2021; 22:1995-2006. [PMID: 34058096 DOI: 10.1080/14656566.2021.1936499] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Introduction: Advances in the treatment of osteosarcoma (OS) came in the mid-1970s, when adding chemotherapy to surgery significantly improved patient survival. OS outcomes have since plateaued, however, despite exhaustive clinical investigations.Area covered: This review focuses on the most significant recent results of trials (in phases II and III) on localized and metastatic/relapsing OS and offers an overview of new targeted drugs.Expert opinion: Recent findings confirm the MAP (methotrexate, doxorubicin, and cisplatin) regimen as the gold standard for OS patients, also in metastatic cases, and the inefficacy of augmenting or modifying chemotherapy in poor responder patients. Immunotherapy and several tyrosine kinase inhibitors seem to be effective and promising in the treatment of OS. Optimizing the use of active drugs available by personalizing chemotherapies might prove important in the future. We urgently need bench-to-bedside research on OS. This will need to involve the extensive sequencing and immunoprofiling of all resected tumor tissue to find new therapeutic agents, especially for relapsing/metastatic patients. The low incidence of OS, its genomic complexity, and differences within and between tumors combine to complicate efforts to elucidate the biology of this disease. This means that we need to pool the resources of different groups studying OS and support translational research.
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Affiliation(s)
- Cristina Meazza
- Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy
| | - Sebastian Dorin Asaftei
- Pediatric Onco-Hematology, Stem Cell Transplantation and Cellular Therapy Division, AOU Città della Salute e della Scienza di Torino, Ospedale Infantile Regina Margherita, Torino, Italy
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Targetable Intercellular Signaling Pathways Facilitate Lung Colonization in Osteosarcoma. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2020. [PMID: 32767237 DOI: 10.1007/978-3-030-43085-6_7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/29/2023]
Abstract
Outcomes for young people diagnosed with osteosarcoma hinge almost exclusively on whether they develop lung metastasis. The striking predilection that osteosarcoma shows for metastatic spread to lung suggests properties and/or lung interactions that generate tissue-specific survival and proliferation advantages. While these mechanisms remain overall poorly defined, studies have begun to describe biological elements important to metastasis. Mechanisms described to date include both cell-autonomous adaptations that allow disseminated tumor cells to survive the stressors imposed by metastasis and intercellular signaling networks that tumor cells exploit to pirate needed signals from surrounding tissues or to recruit other cells that create a more favorable niche. Evidence suggests that cell-autonomous changes are largely driven by epigenetic reprogramming of disseminated tumor cells that facilitates resistance to late apoptosis, manages endoplasmic reticulum (ER) stressors, promotes translation of complex transcripts, and activates clotting pathways. Tumor-host signaling pathways important for lung colonization drive interactions with lung epithelium, mesenchymal stem cells, and mediators of innate and adaptive immunity. In this chapter, we highlight one particular pathway that integrates cell-autonomous adaptations with lung-specific tumor-host interactions. In this mechanism, aberrant ΔNp63 expression primes tumor cells to produce IL6 and CXCL8 upon interaction with lung epithelial cells. This tumor-derived IL6 and CXCL8 then initiates autocrine, osteosarcoma-lung paracrine, and osteosarcoma-immune paracrine interactions that facilitate metastasis. Importantly, many of these pathways appear targetable with clinically feasible therapeutics. Ongoing work to better understand metastasis is driving efforts to improve outcomes by targeting the most devastating complication of this disease.
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12
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Meazza C, Bastoni S, Scanagatta P. What is the best clinical approach to recurrent/refractory osteosarcoma? Expert Rev Anticancer Ther 2020; 20:415-428. [PMID: 32379504 DOI: 10.1080/14737140.2020.1760848] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Introduction: Osteosarcoma is the most common malignant bone tumor. It is currently treated with pre-and postoperative chemotherapy, associated with surgical resection of the tumor.Area covered: Relapses occur in about one in three patients presenting with localized disease, and three in four of those with metastases at diagnosis. Relapsing disease carries a very poor prognosis, with 5-year survival rates ranging between 13% and 40%.Expert opinion: Patients with unilateral lung involvement or solitary lung metastases and a recurrence-free interval (RFI) longer than 24 months have a better prognosis, and could be managed with surgical resection and close observation. Complete surgical resection of all sites of disease remains essential to survival: patients unable to achieve complete remission have a catastrophic overall survival rate. The role of second-line chemotherapy is not at all clear, and no controlled studies are available on this topic. It is worth considering for patients unable to achieve complete surgical remission, and those with multiple metastases and/or a RFI <24 months. Given their dismal prognosis, patients with multiple sites of disease not amenable to complete surgical resection should also be considered for innovative therapeutic approaches.
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Affiliation(s)
- Cristina Meazza
- Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy
| | - Stefano Bastoni
- Center for Oncological Orthopedic Surgery, ASST Azienda Ospedaliera Istituto G Pini-CTO, Milano, Italy
| | - Paolo Scanagatta
- Thoracic Surgery Division, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy
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13
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MAT1 facilitates the lung metastasis of osteosarcoma through upregulation of AKT1 expression. Life Sci 2019; 234:116771. [DOI: 10.1016/j.lfs.2019.116771] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2019] [Revised: 08/05/2019] [Accepted: 08/13/2019] [Indexed: 12/18/2022]
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14
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Heunis JC, Cheah JW, Sabnis AJ, Wustrack RL. Use of three-dimensional printing and intraoperative navigation in the surgical resection of metastatic acetabular osteosarcoma. BMJ Case Rep 2019; 12:12/9/e230238. [PMID: 31570349 DOI: 10.1136/bcr-2019-230238] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
A 21-year-old man underwent a joint-preserving posterior acetabular resection of metastatic osteosarcoma using a three-dimensional (3D) printed model and intraoperative navigation. The combined application of these advanced technologies can allow for surgical planning of osteotomies involving complex anatomy and help guide resections intraoperatively. They can maximise the achievement of negative oncological margins, preservation of native hip stability and critical neurovascular structures, and optimal postoperative function in an effort to resect all clinically evident disease. For this particular patient, with secondary bony metastases, they allowed for a safe and well-tolerated procedure that ultimately afforded him palliative benefit, improved quality of life and, conceivably, prolonged survival in the setting of a devastating prognosis. Although he, sadly, has since passed away, he survived for over 2 years after initial metastasis with preserved hip stability and the ability to graduate college, stay active and maintain a quality of life that addressed his goals of care.
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Affiliation(s)
- Julia C Heunis
- Department of Orthopaedic Surgery, University of California San Francisco, San Francisco, California, USA
| | - Jonathan W Cheah
- Department of Orthopaedic Surgery, University of California San Francisco, San Francisco, California, USA
| | - Amit J Sabnis
- Department of Pediatrics, University of California San Francisco, San Francisco, California, USA
| | - Rosanna L Wustrack
- Department of Orthopaedic Surgery, University of California San Francisco, San Francisco, California, USA
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15
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Spraker-Perlman HL, Barkauskas DA, Krailo MD, Meyers PA, Schwartz CL, Doski J, Gorlick R, Janeway KA, Isakoff MS. Factors influencing survival after recurrence in osteosarcoma: A report from the Children's Oncology Group. Pediatr Blood Cancer 2019; 66:e27444. [PMID: 30255612 PMCID: PMC6249072 DOI: 10.1002/pbc.27444] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2018] [Revised: 07/20/2018] [Accepted: 08/06/2018] [Indexed: 11/07/2022]
Abstract
BACKGROUND Despite drastic improvement in overall survival for pediatric patients with cancer, those with osteosarcoma have stable rates of survival since the 1980s. This project evaluates the effect of several variables on survival after first recurrence in patients with osteosarcoma. METHODS Data from three prospective North American cooperative group trials for newly diagnosed osteosarcoma are included: INT-0133, POG-9754, and AOST0121. The analytic population for this study is all enrolled patients with first event-free survival (EFS) event of relapse. The primary outcome measure for this retrospective analysis was survival after recurrence (SAR). RESULTS The analytic population consisted of N = 431 patients. SAR was statistically significantly associated with age at enrollment (<10 years, P = 0.027), presence of metastatic disease at diagnosis (localized, P < 0.0001), site of relapse (combination lung + bone, unfavorable, P = 0.005), and time to first relapse (2+ years, favorable, P < 0.0001) in multivariate analysis. Ethnicity, primary site of tumor, race, and sex were not significantly related to SAR. CONCLUSIONS Prolonged SAR in patients with relapsed osteosarcoma is associated with age, extent of disease at diagnosis, site of and time to relapse. Adolescent and young adult patients with osteosarcoma have shorter SAR than younger patients, consistent with studies showing decreased overall survival in this group. Although patients with primary metastatic disease have shorter SAR, there is a subset of patients who relapse greater than 2 years from initial diagnosis that will become survivors. Histological response was significantly associated with time to relapse, but was not predictive of SAR.
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Affiliation(s)
| | - Donald A. Barkauskas
- Children’s Oncology Group, Monrovia, CA,Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA
| | - Mark D. Krailo
- Children’s Oncology Group, Monrovia, CA,Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA
| | - Paul A. Meyers
- Department of Pediatrics, Memorial Sloan-Kettering Cancer Center, New York, New York
| | - Cindy L. Schwartz
- Department of Pediatric Hematology-Oncology, Children’s Hospital of Wisconsin, Milwaukee, WI
| | - John Doski
- Department of Surgery/Pediatric Surgery Division, University of Texas Health Science Center, San Rosa Children’s Hospital, San Antonio, TX
| | - Richard Gorlick
- Division of Pediatrics, University of Texas MD Anderson Cancer Center
| | - Katherine A. Janeway
- Department of Pediatric Hematology-Oncology, Dana-Farber/Boston Children’s Cancer and Blood Disorders Center, Boston, Massachusetts
| | - Michael S. Isakoff
- Center for Cancer and Blood Disorders, Connecticut Children’s Medical Center, Hartford, CT
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16
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Ma L, Xue W, Ma X. GATA3 is downregulated in osteosarcoma and facilitates EMT as well as migration through regulation of slug. Onco Targets Ther 2018; 11:7579-7589. [PMID: 30464506 PMCID: PMC6214586 DOI: 10.2147/ott.s176534] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
Background GATA3 functions as a tumor suppressor and has been observed in multiple types of cancer, but the effects and mechanisms of GATA3 in osteosarcoma (OS) are not yet known. Methods The GATA3 expression in OS cells and tissues were detected using quantitative reverse-transcription PCR and Western blotting assay. CCK-8 assay, colony formation assay, wound healing assay as well as transwell assay, were performed to determine the effects of GATA3 on cell proliferation, migration and invasion. ChIP and qChIP as well as luciferase assay were performed whether GATA3 transcriptionally regulated slug expression. Results GATA3 was downregulated in OS cells and tissues. The GATA3 expression was closely associated with tumor size as well as metastasis. GATA3 significantly suppressed OS cells proliferation, migration and invasion. EMT-associated transcript factor, slug, was transcriptionally inhibited by GATA3, thereby regulation of EMT in OS. Conclusion GATA3 serves as a tumor suppressor in OS and suppresses the progression and metastasis of OS through regulation of slug.
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Affiliation(s)
- Linjie Ma
- Department of Orthopedics, Yidu Central Hospital of Weifang City, Qingzhou 262500, People's Republic of China
| | - Wentao Xue
- Department of Orthopedics, Yidu Central Hospital of Weifang City, Qingzhou 262500, People's Republic of China
| | - Xianghai Ma
- Department of Orthopedics, People's Hospital of Juxian, Juxian, Shandong 276500, People's Republic of China,
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17
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Han K, Zhou Y, Tseng KF, Hu H, Li K, Wang Y, Gan Z, Lin S, Sun Y, Min D. PAK5 overexpression is associated with lung metastasis in osteosarcoma. Oncol Lett 2018; 15:2202-2210. [PMID: 29434926 PMCID: PMC5777019 DOI: 10.3892/ol.2017.7545] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2015] [Accepted: 02/23/2017] [Indexed: 02/07/2023] Open
Abstract
p21-activated kinases (PAKs) are multifunctional effectors of Rho GTPases, which are associated with cytoskeletal organization, cellular morphogenesis, migration and survival. PAKs are overactive in a number of tumor tissues and have attracted attention as a potential target for cancer therapy. In the present study, PAK5 levels were analyzed in primary osteosarcoma (OS) samples (n=65) using reverse transcription-quantitative polymerase chain reaction (RT-qPCR) and immunohistochemistry (IHC) methods. In the primary OS tissue, increased PAK5 expression (IHC score >2, n=37) was associated with significantly decreased overall survival (P=0.036) compared with decreased PAK5 expression (IHC score ≤2, n=28). PAK5 expression was identified to be significantly associated with metastasis (P=0.010). The lung is the most common metastasis site for OS. In addition, the level of PAK5 in lung metastasis tissue (n=13) was detected using RT-qPCR and IHC methods. PAK5 expression was increased in lung metastasis tissue compared with in primary OS samples. PAK5 was silenced using short hairpin RNA in OS cell lines. Wound healing, migration and nude mice model assay results consistently demonstrated that PAK5 knockdown was able to significantly inhibit OS migration. In PAK5-knockdown cells, the alteration in the expression of a number of metastasis-associated factors, including epithelial cadherin, vimentin, fibronectin and matrix metalloproteinase 2 (MMP2), was analyzed. Only MMP2 expression was decreased significantly (P<0.05). The expression level of MMP2 was analyzed in primary OS tissue and lung metastasis tissue using RT-qPCR and IHC methods. Expression of MMP2 was identified to be associated with expression of PAK5. The results of the present study suggest that PAK5 promotes OS cell migration and that PAK5 expression may be used to predict lung metastasis.
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Affiliation(s)
- Kun Han
- Oncology Department, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai 200233, P.R. China
| | - Yan Zhou
- Oncology Department, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai 200233, P.R. China
| | - Kuo-Fu Tseng
- Biophysics Department of Oregon State University, Corvallis, OR 97330, USA
| | - Haiyan Hu
- Oncology Department, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai 200233, P.R. China
| | - Kunpeng Li
- School of Life Sciences, Sun Yat-Sen University, Guangzhou, Guangdong 510275, P.R. China
| | - Yaling Wang
- Oncology Department, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai 200233, P.R. China
| | - Zhihua Gan
- Oncology Department, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai 200233, P.R. China
| | - Shuchen Lin
- Oncology Department, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai 200233, P.R. China
| | - Yongning Sun
- Oncology Department, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai 200233, P.R. China
| | - Daliu Min
- Oncology Department, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai 200233, P.R. China
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18
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Kim W, Han I, Lee JS, Cho HS, Park JW, Kim HS. Postmetastasis survival in high-grade extremity osteosarcoma: A retrospective analysis of prognostic factors in 126 patients. J Surg Oncol 2018; 117:1223-1231. [DOI: 10.1002/jso.24963] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2017] [Accepted: 11/27/2017] [Indexed: 11/09/2022]
Affiliation(s)
- Wanlim Kim
- Department of Orthopaedic Surgery; Asan Medical Center; University of Ulsan College of Medicine; Songpa-gu Seoul Korea
| | - Ilkyu Han
- Department of Orthopaedic Surgery; Seoul National University Hospital; Seoul Korea
| | - Jong S. Lee
- Department of Orthopaedic Surgery; Asan Medical Center; University of Ulsan College of Medicine; Songpa-gu Seoul Korea
| | - Hwan S. Cho
- Department of Orthopaedic Surgery; Seoul National University Bundang Hospital; Gyeonggi-do Korea
| | - Jong W. Park
- Orthopaedic Oncology Clinic; National Cancer Center; Ilsandong-gu Goyang-si Gyeonggi-do Korea
| | - Han-Soo Kim
- Department of Orthopaedic Surgery; Seoul National University Hospital; Seoul Korea
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19
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Han S, Andrei AC, Tsui KW. A flexible semiparametric modeling approach for doubly censored data with an application to prostate cancer. Stat Methods Med Res 2016; 25:1718-35. [PMID: 23907782 PMCID: PMC8380435 DOI: 10.1177/0962280213498325] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Doubly censored data often arise in medical studies of disease progression involving two related events for which both an originating and a terminating event are interval-censored. Although regression modeling for such doubly censored data may be complicated, we propose a simple semiparametric regression modeling strategy based on jackknife pseudo-observations obtained using nonparametric estimators of the survival function. Inference is carried out via generalized estimating equations. Simulations studies show that the proposed method produces virtually unbiased covariate effect estimates, even for moderate sample sizes. A prostate cancer study example illustrates the practical advantages of the proposed approach.
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Affiliation(s)
- Seungbong Han
- Department of Clinical Epidemiology and Biostatistics, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Adin-Cristian Andrei
- BCVI Clinical Trials Unit, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Kam-Wah Tsui
- Department of Statistics, University of Wisconsin-Madison, Madison, WI, USA
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20
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Tome Y, Kimura H, Kiyuna T, Sugimoto N, Tsuchiya H, Kanaya F, Bouvet M, Hoffman RM. Disintegrin targeting of an αvβ3 integrin-over-expressing high-metastatic human osteosarcoma with echistatin inhibits cell proliferation, migration, invasion and adhesion in vitro. Oncotarget 2016; 7:46315-46320. [PMID: 27331872 PMCID: PMC5216800 DOI: 10.18632/oncotarget.10111] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2016] [Accepted: 06/03/2016] [Indexed: 02/07/2023] Open
Abstract
The in vitro efficacy of the disintegrin echistatin was tested on a high-metastatic variant of 143B human osteosarcoma, 143B-LM4, which over-expresses αvβ3 integrin. Echistatin is an RGD cyclic peptide and an antagonist of αvβ3 integrin. In the present study, echistatin inhibited cell proliferation, migration, invasion, and adhesion of 143B-LM4 cells. 143B-LM4 cell proliferation decreased after treatment with echistatin in a time-dependent and dose-dependent manner (P <0.01). In vitro migration and invasion of 143B-LM4 cells were also inhibited by echistatin in a dose-dependent manner (P <0.01, respectively). Cell adhesion to vitronectin of 143B-LM4 cells was also inhibited by echistatin in a dose-dependent manner (P <0.01). These results suggest that αvβ3 integrin may be an effective target for osteosarcoma.
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Affiliation(s)
- Yasunori Tome
- AntiCancer, Inc., San Diego, CA 92111, USA.,Department of Surgery, University of California, San Diego, CA 92103, USA.,Department of Orthopedic Surgery, Graduate School of Medicine, University of the Ryukyus, Okinawa, Japan 903-0125
| | - Hiroaki Kimura
- AntiCancer, Inc., San Diego, CA 92111, USA.,Department of Orthopaedic Surgery, Graduate School of Medical Science, Kanazawa University, Kanazawa, Japan 920-8641
| | - Tasuku Kiyuna
- AntiCancer, Inc., San Diego, CA 92111, USA.,Department of Surgery, University of California, San Diego, CA 92103, USA.,Department of Orthopedic Surgery, Graduate School of Medicine, University of the Ryukyus, Okinawa, Japan 903-0125
| | - Naotoshi Sugimoto
- Department of Physiology, Graduate School of Medical Science, Kanazawa University, Kanazawa, Japan 920-8641
| | - Hiroyuki Tsuchiya
- Department of Orthopaedic Surgery, Graduate School of Medical Science, Kanazawa University, Kanazawa, Japan 920-8641
| | - Fuminori Kanaya
- Department of Orthopedic Surgery, Graduate School of Medicine, University of the Ryukyus, Okinawa, Japan 903-0125
| | - Michael Bouvet
- Department of Surgery, University of California, San Diego, CA 92103, USA
| | - Robert M Hoffman
- AntiCancer, Inc., San Diego, CA 92111, USA.,Department of Surgery, University of California, San Diego, CA 92103, USA
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21
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Abstract
PURPOSE The purpose of this study was to analyze the prognostic factors that influence postrelapse survival (PRS) in children and adolescents with initial localized high-grade osteosarcoma. METHODS/PATIENTS This is a retrospective evaluation of patients aged 21 years and below with nonmetastatic high-grade osteosarcoma treated at our institution from 1985 to 2011 who developed recurrent disease after achievement of an initial complete response (CR). PRS and postrelapse event-free survival (PREFS) analyses were performed using the Kaplan-Meier method and log-rank test. Multivariate Cox regression analysis was used to determine which variables were independently prognostic. RESULTS Thirty-one patients were included. Median age at primary diagnosis was 13.7 years (range, 1.9 to 21.0 y). Median time to first relapse was 16 months (range, 3 to 36 mo). Fourteen patients achieved a second CR (CR2) after surgery±chemotherapy treatment. The 5-year PRS and PREFS were both 26% (95% confidence interval, 14%-49%), with a median follow-up of 99 months (range, 27 to 271 mo). Multivariate analysis showed that achievement of CR2 (P<0.001) and histologic response to first-line treatment (P=0.02) were significantly associated with PRS, whereas time to first relapse did not retain univariate significance. CONCLUSIONS Achievement of CR2 and histologic response to preoperative first-line treatment are independent survival prognostic factors in osteosarcoma recurrence.
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22
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Cheng CH, Cheng YP, Chang IL, Chen HY, Wu CC, Hsieh CP. Dodecyl gallate induces apoptosis by upregulating the caspase-dependent apoptotic pathway and inhibiting the expression of anti-apoptotic Bcl-2 family proteins in human osteosarcoma cells. Mol Med Rep 2015; 13:1495-500. [PMID: 26707422 PMCID: PMC4732860 DOI: 10.3892/mmr.2015.4717] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2015] [Accepted: 10/28/2015] [Indexed: 12/25/2022] Open
Abstract
Dodecyl gallate (DG) is a gallic acid ester that has been shown to inhibit tumor growth. The aim of this study was to investigate the mechanism by which DG induces antiproliferative and apoptotic effects in MG-63 human osteosarcoma cells. Dose- and time-dependent cytotoxic effects of DG were determined using an MTT assay. The results showed that the half-maximal inhibitory concentration (IC50) of DG in MG-63 cells was 31.15 µM at 24 h, 10.66 µM at 48 h, and 9.06 µM at 72 h. Flow cytometric analysis demonstrated that exposure to 20 and 40 µM DG resulted in an increase in the sub-G1 phase population and in S-phase cell cycle arrest. Furthermore, western blot analysis of apoptosis-related protein expression revealed an increase in the activation of caspases 8 and 3, cleavage of poly (ADPribose) polymerase (PARP), and disruption of mitochondrial membrane permeability was measured by flow cytometry. An increase in the Bax/Bcl-2 ratio and a decrease in the expression of inhibitor of apoptosis protein (IAP) family members, namely X-linked inhibitor of apoptosis protein and survivin, were also observed following DG treatment. These data provide insight into the molecular mechanisms governing the ability of DG to induce apoptosis in human osteosarcoma cells in vitro.
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Affiliation(s)
- Chun-Hsiang Cheng
- Orthopedics & Sports Medicine Laboratory, Changhua Christian Hospital, Changhua 500‑06, Taiwan, R.O.C
| | - Yen-Po Cheng
- Division of Neurosurgery, Department of Surgery, Changhua Christian Hospital, Changhua 500‑06, Taiwan, R.O.C
| | - Ing-Lin Chang
- Department of Orthopedic Surgery, Changhua Christian Hospital, Changhua 500‑06, Taiwan, R.O.C
| | - Hsin-Yao Chen
- Department of Orthopedic Surgery, Changhua Christian Hospital, Changhua 500‑06, Taiwan, R.O.C
| | - Chia-Chieh Wu
- Department of Orthopedic Surgery, Changhua Christian Hospital, Changhua 500‑06, Taiwan, R.O.C
| | - Chen-Pu Hsieh
- Department of Orthopedic Surgery, Changhua Christian Hospital, Changhua 500‑06, Taiwan, R.O.C
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23
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Daw NC, Chou AJ, Jaffe N, Rao BN, Billups CA, Rodriguez-Galindo C, Meyers PA, Huh WW. Recurrent osteosarcoma with a single pulmonary metastasis: a multi-institutional review. Br J Cancer 2014; 112:278-82. [PMID: 25422914 PMCID: PMC4453448 DOI: 10.1038/bjc.2014.585] [Citation(s) in RCA: 95] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2014] [Accepted: 10/27/2014] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND Late relapse and solitary lesion are positive prognostic factors in recurrent osteosarcoma. METHODS We reviewed the records of 39 patients treated at three major centres for recurrent osteosarcoma with a single pulmonary metastasis more than 1 year after diagnosis. We analysed their outcomes with respect to clinical factors and treatment with chemotherapy. RESULTS Median age at diagnosis was 14.6 years. Relapse occurred at a median of 2.5 years (range, 1.2-8.2 years) after initial diagnosis. At relapse, all patients were treated by metastasectomy; 12 (31%) patients also received chemotherapy. There was no difference in time to recurrence or nodule size between the patients who received or did not receive chemotherapy at relapse. Sixteen patients had no subsequent recurrence, 13 of whom survive without evidence of disease. The 5-year and 10-year estimates of post-relapse event-free survival (PREFS) were 33.0±7.5% and 33.0±9.6%, respectively, and of post-relapse survival (PRS) 56.8±8.6% and 53.0±11.0%, respectively. There was a trend for nodules <1.5 cm to correlate positively with PREFS (P=0.070) but not PRS (P=0.49). Chemotherapy at first relapse was not associated with PREFS or PRS. CONCLUSION Approximately half of the patients with recurrent osteosarcoma presenting as a single pulmonary metastasis more than 1 year after diagnosis were long-term survivors. Metastasectomy was the primary treatment; chemotherapy did not add benefit.
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Affiliation(s)
- N C Daw
- Division of Paediatrics, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | - A J Chou
- Department of Paediatrics, Memorial Sloan-Kettering Cancer Center, New York, NY 10065, USA
| | - N Jaffe
- Division of Paediatrics, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | - B N Rao
- 1] Department of Surgery, St Jude Children's Research Hospital, Memphis, TN 38105, USA [2] Department of Surgery, College of Medicine, University of Tennessee Health Science Center, Memphis, TN 38163, USA
| | - C A Billups
- Department of Biostatistics, St Jude Children's Research Hospital and the University of Tennessee, Memphis, TN 38105, USA
| | - C Rodriguez-Galindo
- 1] Department of Oncology, St Jude Children's Research Hospital, Memphis, TN 38105, USA [2] Department of Paediatrics, College of Medicine, University of Tennessee Health Science Center, Memphis, TN 38105, USA
| | - P A Meyers
- Department of Paediatrics, Memorial Sloan-Kettering Cancer Center, New York, NY 10065, USA
| | - W W Huh
- Division of Paediatrics, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
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24
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Anderson P, Meyers P, Kleinerman E, Venkatakrishnan K, Hughes D, Herzog C, Huh W, Sutphin R, Vyas YM, Shen V, Warwick A, Yeager N, Oliva C, Wang B, Liu Y, Chou A. Mifamurtide in metastatic and recurrent osteosarcoma: a patient access study with pharmacokinetic, pharmacodynamic, and safety assessments. Pediatr Blood Cancer 2014; 61:238-44. [PMID: 23997016 PMCID: PMC4533988 DOI: 10.1002/pbc.24686] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2013] [Accepted: 06/17/2013] [Indexed: 12/29/2022]
Abstract
PURPOSE This non-randomized, patient-access protocol, assessed both safety and efficacy outcomes following liposomal muramyl-tripeptide-phosphatidylethanolamine (L-MTP-PE; mifamurtide) in patients with high-risk, recurrent and/or metastatic osteosarcoma. METHODS Patients received mifamurtide 2 mg/m(2) intravenously twice-weekly ×12 weeks, then weekly ×24 weeks with and without chemotherapy. Serum concentration-time profiles were collected. Adverse events within 24 hours of drug administration were classified as infusion-related adverse events (IRAE); other AEs and overall survival (OS) were assessed. RESULTS The study began therapy in January 2008; the last patient completed therapy in October 2012. Two hundred five patients were enrolled; median age was 16.0 years and 146/205 (71%) had active disease. Mifamurtide serum concentrations declined rapidly in the first 30 minutes post-infusion, then in a log-linear manner 2-6 hours post-dose; t1/2 was 2 hours. There were no readily apparent relationships between age and BSA-normalized clearance, half-life, or pharmacodynamic effects, supporting the dose of 2 mg/m(2) mifamurtide across the age range. Patients reported 3,679 IRAE after 7,482 mifamurtide infusions. These were very rarely grade 3 or 4 and most commonly included chills + fever or headache + fatigue symptom clusters. One- and 2-year OS was 71.7% and 45.9%. Patients with initial metastatic disease or progression approximated by within 9 months of diagnosis (N = 40) had similar 2-year OS (39.9%) as the entire cohort (45.9%) CONCLUSIONS Mifamurtide had a manageable safety profile; PK/PD of mifamurtide in this patient access study was consistent with prior studies. Two-year OS was 45.9%. A randomized clinical trial would be required to definitively determine impact on patient outcomes.
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Affiliation(s)
- P.M. Anderson
- University of Texas M. D. Anderson Cancer Center, Houston, TX, USA
| | - P. Meyers
- Memorial Sloan-Kettering Cancer Center, New York, NY, USA
| | - E. Kleinerman
- University of Texas M. D. Anderson Cancer Center, Houston, TX, USA
| | | | - D.P. Hughes
- University of Texas M. D. Anderson Cancer Center, Houston, TX, USA
| | - C. Herzog
- University of Texas M. D. Anderson Cancer Center, Houston, TX, USA
| | - W. Huh
- University of Texas M. D. Anderson Cancer Center, Houston, TX, USA
| | | | | | - V. Shen
- Childrens Hospital of Orange County, Orange CA USA
| | - A. Warwick
- Uniformed Services University, Bethesda MD, USA
| | - N. Yeager
- Nationwide Children’s Hospital, Ohio State University Columbus OH, USA
| | | | - B. Wang
- Millennium: The Takeda Oncology Company, Cambridge, MA, USA
| | - Y. Liu
- Millennium: The Takeda Oncology Company, Cambridge, MA, USA
| | - A. Chou
- Memorial Sloan-Kettering Cancer Center, New York, NY, USA
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25
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Vijayamurugan N, Bakhshi S. Review of management issues in relapsed osteosarcoma. Expert Rev Anticancer Ther 2013; 14:151-61. [PMID: 24308680 DOI: 10.1586/14737140.2014.863453] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Osteosarcoma is the most common primary malignant bone tumor in children and adolescents. With combined modality treatment long-term survival rate for localized disease is near 70%. Thirty percent of patients relapse with lung as the commonest site. Surgery is the treatment of choice for relapsed patients whenever possible. Addition of chemotherapy to surgery provides survival benefit in patients not achieving second surgical remission. Even patients with multiple lung recurrences can be cured with repeated thoracotomies. Disease-free interval and complete surgical resection are the main prognostic factor for post-relapse survival.
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Affiliation(s)
- Nataraj Vijayamurugan
- Departments of Medical Oncology, Dr. B. R. A. Institute Rotary Cancer Hospital, All India Institute of Medical Sciences, New Delhi-110029, India
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26
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Leary SES, Wozniak AW, Billups CA, Wu J, McPherson V, Neel MD, Rao BN, Daw NC. Survival of pediatric patients after relapsed osteosarcoma: the St. Jude Children's Research Hospital experience. Cancer 2013; 119:2645-53. [PMID: 23625626 DOI: 10.1002/cncr.28111] [Citation(s) in RCA: 91] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2013] [Revised: 02/28/2013] [Accepted: 03/06/2013] [Indexed: 11/06/2022]
Abstract
BACKGROUND Chemotherapy has improved the outcome of patients with newly diagnosed osteosarcoma, but its role in relapsed disease is unclear. METHODS We reviewed the records of all patients who were treated for relapsed high-grade osteosarcoma at our institution between 1970 and 2004. Postrelapse event-free survival (PREFS) and postrelapse survival (PRS) were estimated, and outcome comparisons were made using an exact log-rank test. RESULTS The 10-year PREFS and PRS of the 110 patients were 11.8% ± 3.5% and 17.0% ± 4.3%, respectively. Metastasis at initial diagnosis (14%), and relapse in lung only (75%) were not significantly associated with PREFS or PRS. Time from initial diagnosis to first relapse (RL1) ≥18 months (43%), surgery at RL1 (76%), and ability to achieve second complete remission (CR2, 56%) were favorably associated with PREFS and PRS (P ≤ 0.0002). In patients without CR2, chemotherapy at RL1 was favorably associated with PREFS (P = 0.01) but not with PRS. In patients with lung relapse only, unilateral relapse and number of nodules ( ≤ 3) were associated with better PREFS and PRS (P ≤ 0.0005); no patients with bilateral relapse survived 10 years. The median PREFS after treatment with cisplatin, doxorubicin, methotrexate, and ifosfamide was 3.5 months (95% confidence interval, 2.1-5.2), and the median PRS was 8.2 months (95% confidence interval, 5.2-15.1). CONCLUSIONS Late relapse, surgical resection, and unilateral involvement (in lung relapse only) favorably impact outcome after relapse. Surgery is essential for survival; chemotherapy may slow disease progression in patients without CR2. These data are useful for designing clinical trials that evaluate novel agents.
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Affiliation(s)
- Sarah E S Leary
- Department of Oncology, St. Jude Children's Research Hospital, Memphis, Tennessee, USA
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Wilhelm M, Bielack SS, Zils K, Gosheger G, Friedel G, Lehner B, von Kalle T. Primary Pulmonary Metastatic Osteosarcoma: To Stop or Not to Stop, That is the Question. J Adolesc Young Adult Oncol 2013. [DOI: 10.1089/jayao.2012.0022] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Miriam Wilhelm
- Klinikum Stuttgart—Olgahospital, Pediatrics 5 (Oncology, Hematology, Immunology; Gastroenterology, Rheumatology, General Pediatrics), Stuttgart, Germany
| | - Stefan S. Bielack
- Klinikum Stuttgart—Olgahospital, Pediatrics 5 (Oncology, Hematology, Immunology; Gastroenterology, Rheumatology, General Pediatrics), Stuttgart, Germany
| | - Katja Zils
- Klinikum Stuttgart—Olgahospital, Pediatrics 5 (Oncology, Hematology, Immunology; Gastroenterology, Rheumatology, General Pediatrics), Stuttgart, Germany
| | - Georg Gosheger
- Department of Orthopedics and Tumor Orthopedics, Münster University Hospital, Münster, Germany
| | - Godehard Friedel
- Department of General Thoracic Surgery, Schillerhoehe Hospital, Gerlingen, Germany
| | - Burkhard Lehner
- Department of Orthopedic Surgery and Traumatology, University Hospital of Heidelberg, Heidelberg, Germany
| | - Thekla von Kalle
- Klinikum Stuttgart—Olgahospital, Department of Pediatric Radiology, Stuttgart, Germany
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Rodriguez CO, Crabbs TA, Wilson DW, Cannan VA, Skorupski KA, Gordon N, Koshkina N, Kleinerman E, Anderson PM. Aerosol gemcitabine: preclinical safety and in vivo antitumor activity in osteosarcoma-bearing dogs. J Aerosol Med Pulm Drug Deliv 2010; 23:197-206. [PMID: 19803732 DOI: 10.1089/jamp.2009.0773] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
Abstract
BACKGROUND Osteosarcoma is the most common skeletal malignancy in the dog and in young humans. Although chemotherapy improves survival time, death continues to be attributed to metastases. Aerosol delivery can provide a strategy with which to improve the lung drug delivery while reducing systemic toxicity. The purpose of this study is to assess the safety of a regional aerosol approach to chemotherapy delivery in osteosarcoma-bearing dogs, and second, to evaluate the effect of gemcitabine on Fas expression in the pulmonary metastasis. METHODS We examined the systemic and local effects of aerosol gemcitabine on lung and pulmonary metastasis in this relevant large-animal tumor model using serial laboratory and arterial blood gas analysis and histopathology and immunohistochemistry, respectively. RESULTS AND CONCLUSIONS Six hundred seventy-two 1-h doses of aerosol gemcitabine were delivered. The treatment was well tolerated by these subjects with osteosarcoma (n = 20). Aerosol-treated subjects had metastatic foci that demonstrated extensive, predominately central, intratumoral necrosis. Fas expression was decreased in pulmonary metastases compared to the primary tumor (p = 0.008). After aerosol gemcitabine Fas expression in the metastatic foci was increased compared to lung metastases before treatment (p = 0.0075), and even was higher than the primary tumor (p = 0.025). Increased apoptosis (TUNEL) staining was also detected in aerosol gemcitabine treated metastasis compared to untreated controls (p = 0.028). The results from this pivotal translational study support the concept that aerosol gemcitabine may be useful against pulmonary metastases of osteosarcoma. Additional studies that evaluate the aerosol route of administration of gemcitabine in humans should be safe and are warranted.
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Affiliation(s)
- Carlos O Rodriguez
- William R. Prichard Veterinary Medical Teaching Hospital, University of Texas M.D. Anderson Cancer Center, Houston, Texas, USA.
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Buddingh EP, Anninga JK, Versteegh MIM, Taminiau AHM, Egeler RM, van Rijswijk CSP, Hogendoorn PCW, Lankester AC, Gelderblom H. Prognostic factors in pulmonary metastasized high-grade osteosarcoma. Pediatr Blood Cancer 2010; 54:216-21. [PMID: 19890902 DOI: 10.1002/pbc.22293] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
INTRODUCTION Resection of pulmonary metastases has previously been reported to improve outcome in high-grade osteosarcoma (OS) patients. Factors influencing survival in OS patients with pulmonary metastases are important for clinical decision making. METHODS All 88 OS patients with pulmonary metastases either at diagnosis or during follow-up treated at the Leiden University Medical Center between January 1, 1990 and January 1, 2008 under the age of 40 were included in this study, including 79 cases of conventional, 8 cases of telangiectatic and 1 case of small cell OS. RESULTS In total, 56 of 88 patients with pulmonary metastases were treated by metastasectomy. Resectability of pulmonary metastases was the main prognostic factor. In patients with primary non-metastatic OS, a longer relapse free interval to pulmonary metastases was significantly associated with better survival (P = 0.02). Independent risk factors determining worse survival after metastasectomy in multivariate analysis were male sex (P = 0.05), higher number of pulmonary nodules (P = 0.03), and non-necrotic metastases (P = 0.04). Whether surgery for recurrent pulmonary metastases was performed did not influence survival. Histological subtype of the primary tumor, histological response in the primary tumor after neo-adjuvant chemotherapy, occurrence of local relapse, local resection or amputation of the primary tumor and age at diagnosis did not influence outcome. CONCLUSION This cohort of patients with detailed follow-up data enabled us to identify important risk factors determining survival in OS patients with pulmonary metastases. We demonstrate that after repeated metastasectomies, a subset of patients can be cured.
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Affiliation(s)
- Emilie P Buddingh
- Department of Pediatric Hematology, Oncology and Bone Marrow Transplantation, Leiden University Medical Center, Leiden, The Netherlands
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Macy ME, Sawczyn KK, Garrington TP, Graham DK, Gore L. Pediatric developmental therapies: interesting new drugs now in early-stage clinical trials. Curr Oncol Rep 2009; 10:477-90. [PMID: 18928662 DOI: 10.1007/s11912-008-0073-0] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
The current high cure rates for children diagnosed with cancer can be attributed in part to emphasis on large cooperative group clinical trials. The significant improvement in pediatric cancer survival over the past few decades is the result of optimized chemotherapy drug dosing, timing, and intensity; however, further alterations in traditional chemotherapy agents are unlikely to produce substantially better outcomes. Furthermore, there remains a subset of patients who have a very poor prognosis due to tumor type or stage at presentation, or who have a dismal prognosis with relapse or recurrence. As such, innovative approaches to therapy and new drugs are clearly needed for introduction into the current pediatric oncology arsenal. A variety of biologically targeted therapies that have shown promise in preclinical studies and early-phase adult clinical trials are now being explored in pediatric clinical trials. These novel agents hold the promise for continuing to drive forward improvements in patient survival, with potentially less toxicity than exists with traditional chemotherapy drugs.
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Carrle D, Bielack S. Osteosarcoma lung metastases detection and principles of multimodal therapy. Cancer Treat Res 2009; 152:165-184. [PMID: 20213390 DOI: 10.1007/978-1-4419-0284-9_8] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
The management of pulmonary metastases poses a challenge to the multidisciplinary team involved in the treatment of osteosarcoma. A postal survey on the management of pulmonary metastases in osteosarcoma involving 17 representatives from international study groups and selected institutions was performed in which a response rate of 94% was achieved. The results showed uniform approaches in areas like the imaging methods used for initial staging and the use of manual exploration with thoracotomy. However, it demonstrated diverse practices regarding exploration of the unaffected site in unilateral pulmonary disease, and the approach to lesions disappearing under chemotherapy. Furthermore, agreement on the size of a lesion considered to distinguish between benign and of metastatic origin, varied. Based on the survey and a review of the current literature, detection methods and principles of multimodal therapy will be discussed. Prognostic factors in synchronous and metachronous pulmonary metastases and their implications for a multimodal therapy is also presented.
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Affiliation(s)
- Dorothe Carrle
- Pediatrics 5 (Oncology, Haematology, Immunology), Klinikum Stuttgart, Olgahospital, Bismarckstr. 8, D-70176, Stuttgart, Germany.
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Bielack SS, Kempf-Bielack B, Branscheid D, Carrle D, Friedel G, Helmke K, Kevric M, Jundt G, Kühne T, Maas R, Schwarz R, Zoubek A, Jürgens H. Second and subsequent recurrences of osteosarcoma: presentation, treatment, and outcomes of 249 consecutive cooperative osteosarcoma study group patients. J Clin Oncol 2008; 27:557-65. [PMID: 19075282 DOI: 10.1200/jco.2008.16.2305] [Citation(s) in RCA: 159] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE To evaluate patient and tumor characteristics, treatment, and outcomes in a large cohort of unselected patients with second and subsequent recurrences of osteosarcoma. PATIENTS AND METHODS Two hundred forty-nine consecutive patients who had originally received combined-modality therapy on neoadjuvant Cooperative Osteosarcoma Study Group protocols and went on to develop a total of 409 second and subsequent osteosarcoma recurrences were analyzed for patient-, tumor-, and treatment-related factors and outcomes. RESULTS Five-year overall and event-free survival rates were 16% and 9% for 249 second, 14% and 0% for 93 third, 13% and 6% for 38 fourth, and 18% and 0% for 14 fifth recurrences, respectively. The proportion of recurrences confined to the lungs decreased and the proportion of those with chest wall involvement increased with increasing numbers of recurrences. The duration of relapse-free intervals and the number of lesions at recurrence correlated with outcomes. While only one of 205 patients with rerecurrence survived past 5 years without surgical remission, 5-year overall and event-free survival rates were 32% and 18% for 119 second, 26% and 0% for 45 third, 28% and 13% for 20 fourth, and 53% and 0% for five fifth recurrences, respectively, in which a renewed surgical remission was achieved. The use of chemotherapy correlated with longer survival in patients without surgical remissions. CONCLUSION To our knowledge, this is the first report of survival estimates derived from large cohorts of unselected patients with second and subsequent osteosarcoma recurrences. It confirms the overwhelming importance of surgical clearance. Prognostic indicators after rerecurrences resemble those known from first recurrence. The exact role of re-treatment with chemotherapy, particularly in the adjuvant situation, remains to be defined.
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Affiliation(s)
- Stefan S Bielack
- Klinikum Stuttgart, Olgahospital, Klinik für Kinder und Jugendmedizin, Pädiatrie 5 and Pädiatrie 1, Germany.
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Abstract
PURPOSE OF REVIEW The most recent developments regarding chemotherapy treatment of osteogenic sarcoma are reviewed, with special emphasis on prospective clinical trials and evaluations of late effects of chemotherapy. RECENT FINDINGS In recent years, clinical research has essentially focused on possible refinements of the classic four-drug (methotrexate, cisplatin, doxorubicin and ifosfamide) therapy rather than investigating new drugs. It has been demonstrated that dose-intensification does not improve prognosis. Many investigators have evaluated late chemotherapy-related side effects, particularly in terms of cardiac, renal and auditive toxicity, risk of infertility and of second tumors. Recent findings recommend further studies to define the role of the immunostimulating agent muramyl tripeptide-phosphatidilethanolamine in osteosarcoma. Preclinical and phase II studies suggest an activity of mammalian target of rapamycin (mTOR) inhibitors in osteosarcoma, which also deserves further clinical studies. SUMMARY At present, patients with nonmetastatic osteosarcoma of the extremity aged less than 40 years have an expected 5-year survival rate of 70% with a chemotherapy regimen based on methotrexate, cisplatin, doxorubicin and ifosfamide. Further improvement cannot be achieved by dose intensification of treatment and new strategies are required. Prolonged follow-up is mandatory due to the risk of late effects, second tumors and late relapse from osteosarcoma.
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Affiliation(s)
- Stefano Ferrari
- Chemotherapy Department, Istituto Ortopedico Rizzoli, Bologna, Italy.
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Aarvold A, Bann S, Giblin V, Wotherspoon A, Mudan SS. Osteosarcoma metastasising to the duodenum and pancreas. ACTA ACUST UNITED AC 2007; 89:542-4. [PMID: 17463128 DOI: 10.1302/0301-620x.89b4.18535] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
The incidence of metastatic osteosarcoma is increasing because of improved results following multi-agent chemotherapy and resection of the primary tumour. Metastases occur most commonly in the lungs, whereas bowel metastases are rare. We describe a 25-year-old female who presented with melaena six years after successful resection of an osteosarcoma of her right femur, and one year after resection of a solitary pulmonary metastasis. Imaging revealed a lesion arising within both the duodenum and the pancreas for which a Whipple's pancreatoduodenectomy was carried out, achieving complete resection. Histological examination confirmed the diagnosis of metastatic osteosarcoma. We believe this is only the second such case reported. At 11 months post-operatively she had no detectable disease. Although rare, osteosarcoma can metastasise to the intestine. The surgeon must be aware of this complication, and that bowel metastases are potentially resectable.
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Affiliation(s)
- A Aarvold
- Royal Marsden Hospital, 203, Fulham Road, London SW3, 6JJ, UK
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