Ifosfamide/etoposide alternating with high-dose methotrexate: evaluation of a chemotherapy regimen for poor-risk osteosarcoma

Abstract

Summary Fifteen patients with relapsed osteosarcoma were treated with an intensive combination chemotherapy schedule. Ifosfamide 2.5 g m -2 daily and etoposide 150 mg m -2 daily coincidentally for 3 days and high-dose methotrexate 8 g m -2 (with folinic acid rescue) on days 10-14 in a planned 21-day cycle. Feasibility, toxicity and response to this alternative combination for the treatment of relapsed osteosarcoma was assessed. There were 98 evaluable cycles for toxicity and tolerability. The majority of cycles were well tolerated. Haematological toxicity of grade 3/4 (common toxicity criteria) was seen in all courses. Renal tubular loss of electrolytes, particularly magnesium, occurred in 71% of cycles. Thirteen per cent of cycles were repeated within 21 days and 61% within 28 days. In the thirteen patients evaluable for response, a partial response rate of 31% was seen after two cycles. However, patients with stable disease continued on therapy, and an overall consequent response rate of 62% was observed. Four patients were alive with no evidence of disease at 8-74 months. Three are alive with disease (at 8-19 months). There were six deaths, all disease related. This regimen exhibits an encouraging response rate in a group of children with poor prognosis disease, with a tolerable toxicity profile.

Transient posterior encephalopathy induced by chemotherapy in children

“…In all three patients, total magnesium plasma levels were below normal limits. Hypomagnesemia occurs frequently during cancer chemotherapy y; MTX in association with cyclophosphamide or iphosphamide causes a renal tubulopathy that leads to Mg 2+ loss in 70% of patients [14].…”

Intra-Abdominal Metastasis in Osteosarcoma: Survey and Literature Review

“…The great portion of which was in the liver (4%) and only 0.8% in the pancreas and 2% in other intra-abdominal sites. The characteristics of the 6 OS patients with abdominal metastasis in the COSS studies were not specified [6,7]; the characteristics of the remaining 19 OS patients with abdominal metastasis in the English literature, [2,3]. Metastasis appearing as cystic masses is unexpected.…”

“…Fourteen months after termination of chemotherapy, 2 metastatic lung nodules were detected in the previous metastatic localizations. The nodules were removed with pathological negative margins by metastasectomy and she received second-line chemotherapy consisting of high-dose methotrexate alternating with high-dose ifosfamide (a total of 8 courses) and had continued complete response [3].…”

The feasibility of neoadjuvant high‐dose chemotherapy and autologous peripheral blood stem cell transplantation in patients with nonmetastatic high grade localized osteosarcoma

“…23,24 We also should mention that ifosfamide and etoposide may be used in poor patient responders. 22,25 The period between the beginning of the induction chemotherapy and surgery and the length of chemotherapy administration before surgery still are reported to vary in different studies. 2,21,26,33 Surgery reportedly has been performed at approximately 9 -11 weeks of induction chemotherapy in other studies.…”