Editor’s Note: A previous version of this article incorrectly referred to the treatment arm of this study as MAP; MAPIE, not MAP, failed to improve responses in this setting.
The addition of ifosfamide and etoposide to adjuvant cisplatin, doxorubicin, and high-dose methotrexate (MAP) did not improve event-free survival of patients with newly diagnosed, high-grade osteosarcoma, who respond poorly to neoadjuvant chemotherapy, according to a study published in The Lancet Oncology.1
For this open-label, phase 3 EURAMOS-1 trial, investigators enrolled 618 patients aged 40 years or younger with newly diagnosed osteosarcoma, each of whom had a poor response to preoperative chemotherapy.
After resection, participants were randomly assigned 1:1 to receive MAP or MAP plus ifosfamide and etoposide (MAPIE).
With a median follow-up of 62.1 months, there was no significant difference in event-free survival between the 2 treatment arms (hazard ratio, 0.98; 95% CI, 0.78-1.23).
Patients treated with MAPIE experienced higher rates of grade non-hematologic toxicity than those in the MAP group, though rates of grade 3 to 4 neutropenia and thrombocytopenia were similar between the groups.
One patient in the MAP arm died due to treatment-related infection, and 1 patient died as a result of left ventricular systolic dysfunction in the MAPIE arm, likely due to study treatment.
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The findings suggest that adjuvant MAP chemotherapy should be the standard of care for these patients who have a poor response to preoperative chemotherapy, but new treatment strategies are needed to improve clinical outcomes in this setting.
- Marina NM, Smeland S, Bielack SS, et al. Comparison of MAPIE versus MAP in patients with a poor response to preoperative chemotherapy for newly diagnosed high-grade osteosarcoma (EURAMOS-1): an open-label, international, randomised controlled trial. Lancet Oncol. 2016 Aug 25. doi: 10.1016/S1470-2045(16)30214-5 [Epub ahead of print]