Therapy for osteosarcoma: where do we go from here?
Therapy for osteosarcoma: where do we go from here?
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DOI：
10.2165/00148581-200810050-00005
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发表时间：
2008-01-01
期刊：
影响因子：
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通讯作者：
Gorlick, Richard
中科院分区：
文献类型：
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作者：
Chou, Alexander J;Geller, David S;Gorlick, Richard
骨肉瘤是儿童和青少年最常见的恶性原发性骨肿瘤。目前骨肉瘤的最佳治疗包括多药化疗和侵袭性手术切除所有病变部位。目前国内和国际上对新诊断的骨肉瘤患者的合作试验建立在顺铂、阿霉素和甲氨蝶呤的基础上。本方案旨在阐明（i）在顺铂、多柔比星和甲氨蝶呤的术后化疗中添加异环磷酰胺和依托泊苷是否可改善可切除骨肉瘤患者的无事件生存期和总生存期，这些患者对10周术前化疗的组织学反应较差;和（ii）在用顺铂，阿霉素，甲氨蝶呤提高了可切除骨肉瘤患者的无事件生存率和总生存率，并且术前化疗10周后组织学反应良好。然而，复发或转移性疾病患者的最佳治疗策略（或策略）尚未确定。这仍然是骨肉瘤治疗中的持续挑战之一。最近的治疗进展集中在规避化疗耐药机制，将非经典药物纳入前期治疗，靶向肿瘤微环境，并研究新的递送机制的作用。在局限性疾病患者中，5年生存率至少为70%;转移性或复发性疾病患者中，
Osteosarcoma is the most common malignant primary bone tumor in children and adolescents. Current optimal treatment for osteosarcoma consists of multi-agent chemotherapy and aggressive surgical resection of all sites of disease involvement. The current national and international cooperative trial for patients with newly diagnosed osteosarcoma builds upon the backbone of cisplatin, doxorubicin, and methotrexate. This protocol is designed to clarify whether (i) the addition of ifosfamide and etoposide to postoperative chemotherapy with cisplatin, doxorubicin, and methotrexate improves the event-free survival and overall survival for patients with resectable osteosarcoma and a poor histologic response to 10 weeks of preoperative chemotherapy; and (ii) the addition of pegylated interferon-alpha-2b as maintenance therapy after postoperative chemotherapy with cisplatin, doxorubicin, and methotrexate improves the event-free survival and overall survival for patients with resectable osteosarcoma and a good histologic response to 10 weeks of preoperative chemotherapy. However, the optimal treatment strategy (or strategies) for patients with relapsed or metastatic disease has yet to be defined. This remains one of the persistent challenges in the treatment of osteosarcoma. Recent therapeutic advances have focused on circumventing chemotherapy resistance mechanisms, incorporation of non-classical agents into upfront therapy, targeting of the tumor micro-environment, and investigating the role of novel delivery mechanisms. In patients with localized disease the 5-year survival rate is at least 70%; patients with metastatic or recurrent disease have