Incremental improvement in osteosarcoma chemotherapy?

Osteosarcoma is one of the first solid cancers for which a survival benefit from adjuvant chemotherapy was established [1, 2]. After decades of clinical research to improve on results obtained in the 1980s, the long-standing chemotherapy regimen of doxorubicin and cisplatin with or without methotrexate remains a standard treatment of osteosarcoma, resulting in a 5-year survival rate of more than 60% in patients with localized disease [3, 4]. In patients with metastatic osteosarcoma at diagnosis, or with distant disease relapse after treatment of localized disease, the long-term survival rate is <20%, and new therapies are much needed for this group of patients [5]. Neither the intensification of chemotherapy by adding ifosfamide and etoposide nor the use of muramyl tripeptide or traztuzumab has improved the survival of patients with metastatic osteosarcoma [6–8]. However, cure can be achieved in patients with metastatic osteosarcoma who undergo metastasectomy [5, 9].