Bone Cancer Treatment Regimens

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BONE CANCER TREATMENT REGIMENS

Clinical Trials: The NCCN recommends cancer patient participation in clinical trials as the gold standard for treatment.

Cancer therapy selection, dosing, administration, and the management of related adverse events can be a complex process that should be handled by an experienced healthcare team. Clinicians must choose and verify treatment options based on the individual patient; drug dose modifications and supportive care interventions should be administered accordingly. The cancer treatment regimens below may include both U.S. Food and Drug Administration-approved and unapproved indications/regimens. These regimens are only provided to supplement the latest treatment strategies.

These Guidelines are a work in progress that may be refined as often as new significant data becomes available. The NCCN Guidelines® are a consensus statement of its authors regarding their views of currently accepted approaches to treatment. Any clinician seeking to apply or consult any NCCN Guidelines® is expected to use independent medical judgment in the context of individual clinical circumstances to determine any patient's care or treatment. The National Comprehensive Cancer Network makes no warranties of any kind whatsoever regarding their content, use, or application and disclaims any responsibility for their application or use in any way.

(Revised 8/2016)

© 2016 by Haymarket Media, Inc.

General Treatment Notes1

• Chemotherapy for Ewing's sarcoma and osteosarcoma should include growth factor support.
• Conventional chondrosarcoma (Grades 1–3) has no known standard chemotherapy options.
• Mesenchymal chondrosarcoma: follow Ewing's sarcoma regimens (category 2B).

Chordoma1

Note: All recommendations are category 2A unless otherwise indicated.

REGIMEN

DOSING

Imatinib2,3

Imatinib 800mg orally once daily.

Imatinib + cisplatin4

Imatinib 400mg orally once daily + cisplatin 25mg/m2 weekly.

Imatinib + sirolimus5

Imatinib 400mg orally once daily + sirolimus 2mg orally once daily.

Erlotinib6

Erlotinib 150mg orally once daily.

Sunitinib7

Sunitinib 37.5mg orally once daily.

Lapatinib for epidermal growth factor receptor (EGFR)-positive chordomas (Category 2B)8

Lapatinib 1,500mg orally once daily.

Ewing's Sarcoma and Mesenchymal Chondrosarcoma1

First-line Therapy (Primary/Neoadjuvant/Adjuvant)

VAC/IE (vincristine + doxorubicin + cyclophosphamide alternating with ifosfamide + etoposide)9

Alternating VAC and IE cycles

VAC cycles

Day 1: Vincristine 2mg/m2 (max 2mg) IV + doxorubicin 75mg/m2 IVP + cyclophosphamide 1,200mg/m2 IV. Dactinomycin 1.25mg/m2 IV can be substituted for doxorubicin when a total doxorubicin dose of 375mg/m2 is reached.

IE cycles

Days 1–5: Ifosfamide 1,800mg/m2 IV + mesna + etoposide 100mg/m2 IV.

Repeat each cycle every 3 weeks for 17 cycles.

VAIA (vincristine + dactinomycin [actinomycin D] + ifosfamide + doxorubicin)10,11

Day 1: Vincristine 1.5mg/m2 IV

Days 1-3: Ifosfamide 2,000mg/m2 IV + mesna

Days 1, 3, and 5: Dactinomycin 0.5mg/m2 IV

Days 2 and 4: Doxorubicin 30mg/m2 IV.

Repeat cycle every 21 days for 4 cycles, then proceed to local therapy. After local therapy, high-risk patients should receive 10 additional cycles of VAIA; standard-risk patients should receive 10 additional cycles of VAIA of 10 cycles of VACA:

Day 1: Vincristine 1.5mg/m2 IV + cyclophosphamide 1,200mg/m2 IV + mesna

Days 1, 3, and 5: Dactinomycin 0.5mg/m2 IV

Days 2 and 4: Doxorubicin 30mg/m2 IV.

Repeat cycle every 21 days for 10 cycles.

OR

Days 1, 8, 15, and 22: Vincristine 1.5mg/m2 IV

Days 1, 2, 22, 23, 43, and 44 : Ifosfamide 3,000mg/m2 IV + mesna

Days 1, 2, 43, and 44 : Doxorubicin 30mg/m2 IV

Days 22, 23, and 24: Dactinomycin 0.5mg/m2 IV

After completion of one 9-week cycle, proceed to local therapy. High-risk patients should then receive 3 additional cycles.

VIDE (vincristine + ifosfamide +

doxorubicin + etoposide)12

Day 1: Vincristine 1.5mg/m2 (max 2mg) IV push

Days 1–3: Doxorubicin 20mg/m2 IV + ifosfamide 3g/m2 IV + mesna continuous IV infusion + etoposide 150mg/m2 IV.

Repeat cycle every 3 weeks for up to 6 cycles.

VAC/IE (vincristine + doxorubicin + cyclophosphamide alternating with

ifosfamide + etoposide)9

Alternating VAC and IE cycles

VAC cycles

Day 1: Vincristine 2mg/m2 (max 2mg) IV + doxorubicin 75mg/m2 IV bolus + cyclophosphamide 1,200mg/m2 IV + mesna. Dactinomycin 1.25mg/m2 IV
can be substituted for doxorubicin when a total doxorubicin dose of 375mg/m2
is reached.

IE cycles

Days 1–5: Ifosfamide 1,800mg/m2 IV + mesna + etoposide 100mg/m2 IV.

Repeat each cycle every 3 weeks for 17 cycles.

VAIA (vincristine + dactinomycin [actinomycin D] + ifosfamide + doxorubicin)10,11

Day 1: Vincristine 1.5mg/m2 IV

Days 1-3: Ifosfamide 2,000mg/m2 IV + mesna

Days 1, 3, and 5: Dactinomycin 0.5mg/m2 IV

Days 2 and 4: Doxorubicin 30mg/m2 IV.

Repeat cycle every 21 days for 4 cycles, then proceed to local therapy. After
local therapy, high-risk patients should receive 10 additional cycles of VAIA; standard-risk patients should receive 10 additional cycles of VAIA of 10 cycles
of VACA:

Day 1: Vincristine 1.5mg/m2 IV + cyclophosphamide 1,200mg/m2 IV + mesna

Days 1, 3, and 5: Dactinomycin 0.5mg/m2 IV

Days 2 and 4: Doxorubicin 30mg/m2 IV.

Repeat cycle every 21 days for 10 cycles.

OR

Days 1, 8, 15, and 22: Vincristine 1.5mg/m2 IV

Days 1, 2, 22, 23, 43, and 44 : Ifosfamide 3,000mg/m2 IV + mesna

Days 1, 2, 43, and 44 : Doxorubicin 30mg/m2 IV

Days 22, 23, and 24: Dactinomycin 0.5mg/m2 IV.

After completion of one 9-week cycle, proceed to local therapy. High-risk patients should then receive 3 additional cycles.

VIDE (vincristine + ifosfamide +

doxorubicin + etoposide)12

Day 1: Vincristine 1.5mg/m2 (max 2mg) IV push

Days 1–3: Doxorubicin 20mg/m2 IV + ifosfamide 3g/m2 IV + mesna continuous IV infusion + etoposide 150mg/m2 IV.

Repeat cycle every 3 weeks for up to 6 cycles.

VAdriaC (vincristine + doxorubicin + cyclophosphamide + dactinomycin)13

Day 1: Vincristine 2mg/m2 IV + cyclophosphamide 1,200mg/m2 +
doxorubicin 75mg/m2 (the first 5 cycles) Or dactinomycin 1.25mg/m2 IV (subsequent cycles).

Repeat cycle every 3 weeks for 17 cycles.

Second-line Therapy (Relapsed/Refractory Disease or Metastatic Disease)

Cyclophosphamide + topotecan14–17

Days 1–5: Cyclophosphamide 250mg/m2/day IV + topotecan 0.75mg/m2/day IV, each given as a 30-minute infusion once daily for 5 days.

Repeat cycle every 3 weeks for 12–14 cycles.

Irinotecan ± temozolomide18–24

Days 1–5: Temozolomide 100mg/m2/day orally, plus

Days 1–5 and 8–12: Irinotecan 10–20mg/m2/day IV at least 1 hour after temozolomide.

Repeat cycle every 3 or 4 weeks.

Ifosfamide (high dose) ± etoposide25,26

Days 1–5: Ifosfamide 1,800mg/m2/day IV + mesna

Days 1–5: Etoposide 100mg/m2/day IV.

Repeat every 3 weeks for 12 cycles.

Ifosfamide + carboplatin + etoposide27

Days 1 and 2: Carboplatin 400mg/m2/day IV, plus

Days 1–5: Ifosfamide 1,800mg/m2/day IV + mesna +
etoposide 100mg/m2/day IV.

Repeat cycle every 3 weeks for up to 12 cycles (median 1 cycle).

Docetaxel + gemcitabine28

Days 1 and 8: Gemcitabine 675mg/m2 IV, plus

Day 8: Docetaxel 75–100mg/m2 IV.

Repeat cycle every 3 weeks for up to 13 cycles (median 4 cycles).

Giant Cell Tumor of Bone1

Denosumab29,30

Denosumab 120mg subcutaneously every 4 weeks with additional doses on
Days 8 and 15.

Interferon alfa31-33

Interferon alpha-2 or beta (3,000,000 units/m2) 48 to 72 hours postoperatively Or

increasing dosage from 4 x 106 units 3 times a week to 9 × 106 units 3 times a week.

Peginterferon33

Peginterferon alfa-2a 1.0μ/kg SQ injection weekly.

Osteosarcoma1

First-line Therapy (Primary/Neoadjuvant/Adjuvant Therapy or Metastatic Disease)

Cisplatin + doxorubicin34–36

Days 1–3: Doxorubicin 25mg/m2/day IV, plus

Day 1: Cisplatin 100mg/m2 IV continuous IV infusion.

Repeat cycle every 3 weeks for 6 cycles.

MAP (high-dose methotrexate + cisplatin + doxorubicin)37,38

Preoperative Chemotherapy

Days 1 and 28: Methotrexate 8g/m2 IV followed by citrovorum factor rescue

Days 7-9 and 34-36: Cisplatin 120mg/m2 by intra-arterial infusion for 72 hours

Days 9 and 36: Doxorubicin 60mg/m2 IV starting 8 hours after the beginning of cisplatin.

Postoperative Chemotherapy (Necrosis ≥90%)

Days 1, 48, 96, and 144: Doxorubicin 45mg/m2/day for 2 consecutive days in a 4-hour IV infusion

Days 21, 69, and 117: Methotrexate 8g/m2 IV followed by citrovorum factor rescue

Days 27, 75, and 123: Cisplatin 120mg/m2 by intra-arterial infusion for 72 hours.

Postoperative Chemotherapy (Necrosis <90%)

Days 1, 69, 138, and 207: Doxorubicin 45mg/m2/day for 2 consecutive days in a 4-hour IV infusion

Days 21, 90, and 159: Ifosfamide 2g/m2/day IV for 5 consecutive days in 90 minutes + mesna

Days 42, 111, and 180: Methotrexate 8g/m2 IV followed by citrovorum factor rescue

Days 48, 117, and 186: Etoposide 120mg/m2/day in a 1-hour infusion for 3 days.

Doxorubicin + cisplatin + ifosfamide + high-dose methotrexate39

Days 0, 6, 18, 27, and 36: Methotrexate 12g/m2 as a 4-hour infusion,
increased by 2g/m2 if the hour-4 level of serum methotrexate in the previous course was <1000 µmol/L

Days 1, 7, 19, 28, and 37: Cisplatin 60mg/m2/day as a 48-hour continuous
IV infusion (total dose 120mg/m2)

Days 1 and 7: Doxorubicin (preoperative): 75mg/m2 as a 24-hour
continuous IV infusion

Day 12: Surgery

Days 13, 22, and 31: Doxorubicin (postoperative): 90mg/m2 as a 24-hour continuous IV infusion

Days 4, 10, 16, 25, and 34: Ifosfamide: 3 g/m2/day as a 120-hour (5-day) continuous IV infusion (total dose 15g/m2).

Ifosfamide + cisplatin + epirubicin40

Day 1: Epirubicin 90mg/m2 IV + cisplatin 100mg/m2 IV

Days 2–4: Ifosfamide 2.0g/m2 with an equivalent dose of mesna, repeated every 21 days. Six cycles of this combination regimen were administered (3 cycles preoperatively and 3 cycles postoperatively).

Second-line Therapy (Relapsed/Refractory or Metastatic Disease)

Carboplatin + ifosfamide + etoposide27

Days 1 and 2: Carboplatin 400mg/m2/day IV, plus

Days 1–5: Ifosfamide 1,800mg/m2/day IV + mesna + etoposide 100mg/m2/day IV.

Repeat cycle every 3 weeks for up to 12 cycles (median 1 cycles).

Gemcitabine + docetaxel28

Days 1 and 8: Gemcitabine 675mg/m2 IV, plus

Day 8: Docetaxel 75–100mg/m2 IV.

Repeat cycle every 3 weeks for up to 13 cycles (median 4 cycles).

Cyclophosphamide + topotecan17

Days 1–5: Cyclophosphamide 250mg/m2/day IV + topotecan 0.75mg/m2/day IV, each given as a 30-minute infusion once daily for 5 days.

Repeat cycle every 3 weeks for 12–14 cycles.

Sorafenib41

Sorafenib 400mg orally twice daily until progression or unacceptable toxicity.

Ifosfamide (high dose) ± etoposide25,26

Days 1–5: Ifosfamide 1,800mg/m2/day IV + mesna, plus

Days 1–5: Etoposide 100mg/m2/day IV.

Repeat every 3 weeks for 12 cycles.

Cyclophosphamide + etoposide42

Day 1: Cyclophosphamide 4,000mg/m2 3-hour IV infusion; all patients received mesna 1,400mg/m2 before and after 4 hours and 8 hours from cyclophosphamide start

Days 2–4: Etoposide 100mg/m2 over 1 hour twice daily for 3 days on Days 2, 3, and 4 (total dose 600mg/m2).

Gemcitabine43

Days 1 and 8: Gemcitabine 1,200mg/m2 IV.

Repeat cycle every 21 days.

High-dose methotrexate + etoposide + ifosfamide44

Weeks 1, 2, 3, 7, 8, 12, and 13: High-dose methotrexate IV

Weeks 4 and 9: Etoposide 75mg/m2/day IV + ifosfamide 3g/m2/day + mesna 3.6mg/m2/day continuous IV infusion for 4 days.

Sorafenib + everolimus45

Sorafenib 800mg orally + everolimus 5mg orally once daily until disease progression or unacceptable toxicity.

153Sm-EDTMP (for relapsed
or refractory disease beyond second-line therapy)
46

Samarium-153 ethylene diamine tetramethylene phosphonate (153Sm-EDTMP) 1.0, 3.0, 4.5, 6.0, 12.0, 19.0, or 30.0mCi/kg can be considered; however, the 30mCi/kg dosage requires peripheral-blood progenitor cell grafts with more than 2 x 106 CD34(+)/kg to overcome the myeloablative effects of skeletal irradiation.

223RA47-49

Three 75kBq/kg 223RA infusion given in 4-week intervals (total administered
dose of 14.44MBq or 0.390mCi); 223RA doses of 50kBq/kg and 100Bq/kg are being investigated.

* Indicated for high-grade chondrosarcoma for systemic recurrence.

† Dactinomycin can be substituted for doxorubicin because of concerns regarding cardiotoxicity.

References

1. Referenced with permission from the NCCN Clinical Practice Guidelines in Oncology™. Breast Cancer. v2.2016. Available at: http://www.nccn.org/ professionals/physician_gls/pdf/bone.pdf. Accessed February 19, 2016.

2. Casali PG, Messina A, Stacchiotti S, et al. Imatinib mesylate in chordoma. Cancer. 2004;101(9):2086–2097.

3. Stacchiotti S, Longhi A, Ferraresi V, et al. Phase II study of imatinib in advanced chordoma. J Clin Oncol. 2012;30(9):914–920.

4. Casali PG, Stacchiotti S, Sangalli C, et al. Chordoma. Current Opin Oncol. 2007;19(4):367–370.

5. Stacchiotti S, Marrari A, Tamborini E, et al. Response to imatinib plus sirolimus in advanced chordoma. Ann Oncol. 2009;20(11):1886–1894.

6. Singhal N, Kotasek D, Parnis FX. Response to erlotinib in a ­patient with treatment refractory chordoma. Anti Cancer Drugs. 2009;20(10):953–955

7. George S, Merriam P, Maki RG, et al. Multicenter phase II trial of sunitinib in the treatment of nongastrointestinal stromal tumor sarcomas. J Clin Oncol. 2009;27(19):3154–3160.

8. Stacchiotti S, Tamborini E, LoVullo S, et al. A phase II study on lapatinib in advanced EGFR-positive chordoma. Ann Oncol. 2013;24(7):1931–1936.

9. Grier HE, Krailo MD, Tarbell NJ, et al. Addition of ifosfamide and etoposide to standard chemotherapy for Ewing's sarcoma and primitive neuroectodermal tumor of bone. N Engl J Med. 2003;348(8):694–701.

10. Paulussen M, Craft AW, Lewis I, et al; European Intergroup ­Cooperative Ewing's Sarcoma Study-92. Results of the EICESS-92 Study: two randomized trials of Ewing's sarcoma treatment—cyclophosphamide compared with ifosfamide in standard-risk patients and assessment of benefit of etoposide added to standard treatment in high-risk patients. J Clin Oncol. 2008;26(27):4385–4393.

11. Paulussen M, Ahrens S, Dunst J, et al. Localized Ewing tumor of bone: final results of the cooperative Ewing's Sarcoma Study CESS 86. J Clin Oncol. 2001;19:1818–1829.

12. Juergens C, Weston C, Lewis I, et al. Safety assessment of ­intensive induction with vincristine, ifosfamide, doxorubicin, and etoposide (VIDE) in the treatment of Ewing tumors in the EURO-E.W.I.N.G. 99 clinical trial. Pediatr Blood Cancer. 2006;47(1):22–29.

13. Miser JS, Krailo MD, Tarbell NJ, et al. Treatment of metastatic Ewing's sarcoma or primitive neuroectodermal tumor of bone: evaluation of combination ifosfamide and etoposide—a ­Children's Cancer Group and Pediatric Oncology Group study. J Clin Oncol. 2004;22(14):2873–2876.

14. Bernstein ML, Devidas M, Lafreniere D, et al. Intensive therapy with growth factor support for patients with Ewing tumor metastatic at diagnosis: Pediatric Oncology Group/Children's Cancer Group Phase II Study 9457—a report from the Children's Oncology Group. J Clin Oncol. 2006;24(1):152–159.

15. Hunold A, Weddeling N, Paulussen M, Ranft A, Liebscher C, Jürgens H. Topotecan and cyclophosphamide in patients with refractory or relapsed Ewing tumors. Pediatr Blood Cancer. 2006;47(6):795–800.

16. Kushner BH, Kramer K, Meyers PA, et al. Pilot study of topotecan and high-dose cyclophosphamide for resistant pediatric solid tumors. Med Pediatr Oncol. 2000;35(5):468–474.

17. Saylors RL 3rd, Stine KC, Sullivan J, et al; Pediatric Oncology Group. Cyclophosphamide plus topotecan in children with ­recurrent or refractory solid tumors: a Pediatric Oncology Group phase II study. J Clin Oncol. 2001;19915):3463–3469.

18. Casey DA, Wexler LH, Merchant MS, et al. Irinotecan and ­temozolomide for Ewing sarcoma: the Memorial Sloan-­Kettering Experience. Pediatr Blood Cancer. 2009;53(6):1029–1034.

19. Wagner LM, McAllister N, Goldsby RE, Rausen AR, McNall- Knapp RY, McCarville MB, Albritton K. Temozolomide and intravenous irinotecan for treatment of advanced Ewing sarcoma. Pediatr Blood Cancer. 2007;48(2):132–139.

20. Wagner LM, Crews KR, Iacono LC, et al. Phase I trial of ­temozolomide and protracted irinotecan in pediatric patients with refractory solid tumors. Clin Cancer Res. 2004;10(3):840–848.

21. McNall-Knapp RY, Williams CN, Reeves EN, et al. Extended phase I evaluation of vincristine, irinotecan, temozolomide, and antibiotic in children with refractory solid tumors. Pediatr Blood Cancer. 2010;54(7):909–915.

22. Blaney S, Berg SL, Pratt C, et al. A phase I study of irinotecan in pediatric patients: a pediatric oncology group study. Clin Cancer Res. 2001;7(1):32–37.

23. Furman WL, Stewart CF, Poquette CA, et al. Direct translation of a protracted irinotecan schedule from a xenograft model to a phase I trial in children. J Clin Oncol. 1999;17(6):1815–1824.

24. McGregor LM, Stewart CF, Crews KR, et al. Dose escalation of intravenous irinotecan using oral cefpodoxime: a phase I study in pediatric patients with refractory solid tumors. ­Pediatr Blood Cancer. 2012;58(3):372–379.

25. Miser JS, Kinsella TJ, Triche TJ, et al. Ifosfamide with mesna uroprotection and etoposide: an effective regimen in the treatment of recurrent sarcomas and other tumors of children and young adults. J Clin Oncol. 1987;5(8):1191–1198.

26. Magnan H, Goodbody CM, Riedel E, Pratilas CA, Wexler LH, Chou AJ. Ifosfamide dose-intensification for patients with
metastatic Ewing sarcoma. Pediatr Blood Cancer. 2015;62(4):594–597.

27. Van Winkle P, Angiolillo A, Krailo M, et al. Ifosfamide, carboplatin, and etoposide (ICE) reinduction chemotherapy in a large ­cohort of children and adolescents with recurrent/refractory sarcoma: the Children's Cancer Group (CCG) experience. ­Pediatr Blood Cancer. 2005;44(4):338–347.

28. Navid F, Willert JR, McCarville MB, Furman W, Watkins A, ­Roberts W, Daw NC. Combination of gemcitabine and docetaxel in the treatment of children and young adults with refractory bone sarcoma. Cancer. 2008;113(2):419–425.

29. Branstetter DG, Nelson SD, Manivel JC, et al. Denosumab induces tumor reduction and bone formation in patients with giant-cell tumor of bone. Clin Cancer Res. 2012;18(16):4415–4424.

30. Thomas D, Henshaw R, Skubitz K, et al. Denosumab in patients with giant-cell tumour of bone: an open-label, phase 2 study. Lancet Oncol. 2010;11(3):275–280.

31. Kaiser U, Neumann K, Havemann K. Generalised giant-cell ­tumour of bone: successful treatment of pulmonary metastases with interferon alpha, a case report. J Cancer Res Clin Oncol. 1993;119(5):301–303.

32. Kaban LB, Troulis MJ, Ebb DJ, et al. Antiangiogenic therapy with interferon alpha for giant cell lesions of the jaws. Oral Maxillofac Surg. 2002;60(10):1103–1113.

33. Yasko AW. Interferon therapy for giant cell tumor of bone. Curr Opin Orthop. 2006;17(6):568–572.

34. Bramwell VH, Burgers M, Sneath R, et al. A comparison of two short intensive adjuvant chemotherapy regimens in operable osteosarcoma of limbs in children and young adults: the first study of the European Osteosarcoma Intergroup. J Clin Oncol. 1992;10(10):1579–1591

35. Lewis IJ, Nooij MA, Whelan J, et al; MRC BO06 and EORTC 80931 collaborators; European Osteosarcoma Intergroup. ­Improvement in histologic response but not survival in osteosarcoma patients treated with intensified chemotherapy: a randomized phase III trial of the European Osteosarcoma Intergroup. J Natl Cancer Inst. 2007;99(2):112–128.

36. Souhami RL, Craft AW, Van der Eijken JW, et al. Randomised trial of two regimens of chemotherapy in operable osteosarcoma: a study of the European Osteosarcoma Intergroup. Lancet. 1997;350(9082):911–917.

37. Bacci G, Ferrari S, Bertoni F, et al. Long-term outcome for ­patients with nonmetastatic osteosarcoma of the extremity treated at the istituto ortopedico rizzoli according to the ­istituto ortopedico rizzoli/osteosarcoma-2 protocol: an ­updated report. J Clin Oncol. 2000;18(24):4016–4027.

38. Winkler K, Beron G, Delling G. Neoadjuvant chemotherapy of osteosarcoma: results of a randomized cooperative trial (COSS-82) with salvage chemotherapy based on histological tumor response. J Clin Oncol. 1988;6(2):329–337.

39. Bacci G, Briccoli A, Rocca M, et al. Neoadjuvant chemo­therapy for osteosarcoma of the extremities with metastases at presentation: recent experience at the Rizzoli Institute in 57 patients treated with cisplatin, doxorubicin, and a high dose of methotrexate and ifosfamide. Ann Oncol. 2003;14(7):1126–1134.

40. Basaran M, Bavbek ES, Saglam S, et al. A phase II study of cisplatin, ifosfamide and epirubicin combination chemotherapy in adults with nonmetastatic and extremity osteosarcomas. Oncology. 2007;72(3–4):255–260.

41. Grignani G, Palmerini E, Dileo P, et al. A phase II trial of sorafenib in relapsed and unresectable high-grade osteo­sarcoma after failure of standard multimodal therapy: an Italian Sarcoma Group study. Ann Oncol. 2012;23(2):508–516.

42. Berger M, Grignani G, Ferrari S, et al. Phase 2 trial of two courses of cyclophosphamide and etoposide for relapsed high-risk osteosarcoma patients. Cancer. 2009;115(13):2980–2987.

43. Maki RG, Wathen JK, Patel SR, et al. Randomized phase II study of gemcitabine and docetaxel compared with gemcitabine alone in patients with metastatic soft tissue sarcomas: results of sarcoma alliance for research through collaboration study 002. J Clin Oncol. 2007;25(19):2755–2763.

44. Le Deley MC, Guinebretiere JM, Gentet JC, et al. SFOP OS93: a randomised trial comparing preoperative high-dose methotrexate plus doxorubicin to high-dose methotrexate plus etoposide and ifosfamide in osteosarcoma patients. Eur J Cancer. 2007;43(4);752–761.

45. Grignani G, Palmerini E, Ferraresi V, et al. Italian Sarcoma Group. Sorafenib and everolimus for patients with unresectable high-grade osteosarcoma progressing after standard treatment: a non-randomised phase 2 clinical trial. Lancet Oncol. 2015;16(1):98–107.

46. Anderson PM, Wiseman GA, Dispenzieri A, et al. High-dose
samarium-153 ethylene diamine tetramethylene phosphonate: low toxicity of skeletal irradiation in patients with osteosarcoma and bone metastases. J Clin Oncol. 2002;20(1):189–196.

47. Subbiah V, Anderson P, Rohren E. Alpha emitter radium 223 in high-risk osteosarcoma: first clinical evidence of response and blood-brain barrier penetration. JAMA Oncol. 2015;1(2):253–255.

48. Anderson PM, Subbiah V, Rohren E. Bone-seeking radio­pharmaceuticals as targeted agents of osteosarcoma: samarium-153-EDTMP and radium-223. Adv Exp Med Biol. 2014;804:291–304.

49. Subbiah V, Rohren E, Huh W, Kappadath C, Anderson PM. Phase 1 dose escalation trial of intravenous radium 223 dichloride alpha-particle therapy in osteosarcoma. J Clin Oncol. 2014;32(5s): Abstract TPS10600.


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