Adolescents and Young Adults (AYAs) With Initially Localized and Metastatic Bone Sarcomas: A Retrospective Single Center Analysis of Side Effect Management

Overview

Journal In Vivo

Specialty Oncology

Date 2021 Jan 6

PMID 33402487

Citations 3

Authors

Christoph Minichsdorfer

Oskar Steinbrecher

Marita Kolz

Maximilian Schmid

Markus Raderer

Thomas Brodowicz

Wolfgang Lamm

Affiliations

Soon will be listed here.

Abstract

Background/aim: Ewing sarcoma (ES) and osteosarcomas (OSA) are the most common bone tumor types in adolescents and young adults (AYA). Therapy management of these tumors consists of preoperative chemotherapy, operation, and postoperative chemotherapy. The aim of this study was to evaluate the efficacy and tolerability of EURAMOS-A and EURO E.W.I.N.G. protocols.

Patients And Methods: We retrospectively evaluated 31 patients between 18 and 39 years of age with ES and OSA treated at the Department of Medicine I, Clinical Division of Oncology. Patients with ES were treated according the EURO E.W.I.N.G protocol, whereas patients with OSA according to the EURAMOS-1 protocol.

Results: Most frequent tumor sites for ES were thorax and pelvis, each 33%. Eight patients had initially localized disease (67%). A median of 3 cycles of full dose chemotherapy could be administered. Nine patients had a dose reduction (75%). Most common reason for dose reduction was prolonged aplasia (67%). Overall response rate (ORR) was 33%. For OSA patients, the most frequent tumor site was the lower extremity (58%). Sixteen patients (84%) had initially localized disease. A median of only 9 cycles of EURAMOS-1 in full dose could be administered. Most common reason for dose reduction was elevated methotrexate level (53%) and ORR was 90%.

Conclusion: The two studied protocols were well-tolerated in the AYA patients included in this study. Dose reductions instead of dose delays should be considered when side effects occur.

Citing Articles

Long-term Outcomes of Biological Reconstruction for Primary Bone Sarcoma of the Humerus.

Kinoshita H, Stevenson J, Morris G, Kurisunkal V, Shreemal B, Abudu A Cancer Diagn Progn. 2025; 5(2):153-161.

PMID: 40034949 PMC: 11871867. DOI: 10.21873/cdp.10425.

Viable tumor cell density after neoadjuvant chemotherapy assessed using deep learning model reflects the prognosis of osteosarcoma.

Kawaguchi K, Miyama K, Endo M, Bise R, Kohashi K, Hirose T NPJ Precis Oncol. 2024; 8(1):16.

PMID: 38253709 PMC: 10803362. DOI: 10.1038/s41698-024-00515-y.

Does primary tumor resection improve survival for patients with sarcomas of pelvic bones, sacrum, and coccyx who have metastasis at diagnosis ?.

Hu X, Fujiwara T, Sun Y, Huang W, Yan W Eur Spine J. 2023; 32(12):4362-4376.

PMID: 37870700 DOI: 10.1007/s00586-023-07985-x.

Feasibility and Toxicity of Interval-Compressed Chemotherapy in Asian Children and Young Adults with Sarcoma.

Huang J, Chen S, Liao Y, Kao Y, Ho W, Chang H J Pers Med. 2023; 13(4).

PMID: 37109054 PMC: 10146212. DOI: 10.3390/jpm13040668.

References

Eisenhauer E, Therasse P, Bogaerts J, Schwartz L, Sargent D, Ford R . New response evaluation criteria in solid tumours: revised RECIST guideline (version 1.1). Eur J Cancer. 2008; 45(2):228-47. DOI: 10.1016/j.ejca.2008.10.026. View

Cangir A, Vietti T, Gehan E, BURGERT Jr E, Thomas P, Tefft M . Ewing's sarcoma metastatic at diagnosis. Results and comparisons of two intergroup Ewing's sarcoma studies. Cancer. 1990; 66(5):887-93. DOI: 10.1002/1097-0142(19900901)66:5<887::aid-cncr2820660513>3.0.co;2-r. View

Le Deley M, Paulussen M, Lewis I, Brennan B, Ranft A, Whelan J . Cyclophosphamide compared with ifosfamide in consolidation treatment of standard-risk Ewing sarcoma: results of the randomized noninferiority Euro-EWING99-R1 trial. J Clin Oncol. 2014; 32(23):2440-8. DOI: 10.1200/JCO.2013.54.4833. View

Rosen G, WOLLNER N, Tan C, Wu S, HAJDU S, Cham W . Proceedings: Disease-free survival in children with Ewing's sarcoma treated with radiation therapy and adjuvant four-drug sequential chemotherapy. Cancer. 1974; 33(2):384-93. DOI: 10.1002/1097-0142(197402)33:2<384::aid-cncr2820330213>3.0.co;2-t. View

Ganjoo K, Patel S . The treatment outcome for adult patients with Ewing's sarcoma. Curr Oncol Rep. 2013; 15(4):372-7. DOI: 10.1007/s11912-013-0317-5. View

Ewing J . The Classic: Diffuse endothelioma of bone. Proceedings of the New York Pathological Society. 1921;12:17. Clin Orthop Relat Res. 2006; 450:25-7. DOI: 10.1097/01.blo.0000229311.36007.c7. View

Juergens C, Weston C, Lewis I, Whelan J, Paulussen M, Oberlin O . 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):22-9. DOI: 10.1002/pbc.20820. View

Smeland S, Bruland O, Hjorth L, Brosjo O, Bjerkehagen B, Osterlundh G . Results of the Scandinavian Sarcoma Group XIV protocol for classical osteosarcoma: 63 patients with a minimum follow-up of 4 years. Acta Orthop. 2011; 82(2):211-6. PMC: 3235293. DOI: 10.3109/17453674.2011.566141. View

Pieper S, Ranft A, Braun-Munzinger G, Jurgens H, Paulussen M, Dirksen U . Ewing's tumors over the age of 40: a retrospective analysis of 47 patients treated according to the International Clinical Trials EICESS 92 and EURO-E.W.I.N.G. 99. Onkologie. 2008; 31(12):657-63. DOI: 10.1159/000165361. View

10.

Gasparini M . High-dose ifosfamide alone and in combination for solid malignancies in childhood. Cancer Chemother Pharmacol. 1986; 18 Suppl 2:S18. DOI: 10.1007/BF00647442. View

11.

Marina N, Smeland S, Bielack S, Bernstein M, Jovic G, Krailo M . 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; 17(10):1396-1408. PMC: 5052459. DOI: 10.1016/S1470-2045(16)30214-5. View

12.

Goorin A, Harris M, Bernstein M, Ferguson W, Devidas M, Siegal G . Phase II/III trial of etoposide and high-dose ifosfamide in newly diagnosed metastatic osteosarcoma: a pediatric oncology group trial. J Clin Oncol. 2002; 20(2):426-33. DOI: 10.1200/JCO.2002.20.2.426. View

13.

White V, Orme L, Skaczkowski G, Pinkerton R, Coory M, Osborn M . Management of Sarcoma in Adolescents and Young Adults: An Australian Population-Based Study. J Adolesc Young Adult Oncol. 2019; 8(3):272-280. DOI: 10.1089/jayao.2018.0136. View

14.

Whelan J, Bielack S, Marina N, Smeland S, Jovic G, Hook J . EURAMOS-1, an international randomised study for osteosarcoma: results from pre-randomisation treatment. Ann Oncol. 2014; 26(2):407-14. PMC: 4304379. DOI: 10.1093/annonc/mdu526. View

15.

Cho W, Song W, Jeon D, Kong C, Kim M, Lee J . Differential presentations, clinical courses, and survivals of osteosarcomas of the proximal humerus over other extremity locations. Ann Surg Oncol. 2009; 17(3):702-8. DOI: 10.1245/s10434-009-0825-6. View

16.

Whelan J, Le Deley M, Dirksen U, Le Teuff G, Brennan B, Gaspar N . High-Dose Chemotherapy and Blood Autologous Stem-Cell Rescue Compared With Standard Chemotherapy in Localized High-Risk Ewing Sarcoma: Results of Euro-E.W.I.N.G.99 and Ewing-2008. J Clin Oncol. 2018; :JCO2018782516. PMC: 6209090. DOI: 10.1200/JCO.2018.78.2516. View

17.

Kager L, Zoubek A, Potschger U, Kastner U, Flege S, Kempf-Bielack B . Primary metastatic osteosarcoma: presentation and outcome of patients treated on neoadjuvant Cooperative Osteosarcoma Study Group protocols. J Clin Oncol. 2003; 21(10):2011-8. DOI: 10.1200/JCO.2003.08.132. View

18.

Raze T, Lacour B, Cowppli-Bony A, Delafosse P, Velten M, Tretarre B . Cancer Among Adolescents and Young Adults Between 2000 and 2016 in France: Incidence and Improved Survival. J Adolesc Young Adult Oncol. 2020; 10(1):29-45. DOI: 10.1089/jayao.2020.0017. View

19.

Mirabello L, Troisi R, Savage S . International osteosarcoma incidence patterns in children and adolescents, middle ages and elderly persons. Int J Cancer. 2009; 125(1):229-34. PMC: 3048853. DOI: 10.1002/ijc.24320. View