The safety of current pharmacotherapeutic strategies for osteosarcoma

ABSTRACT

Introduction: Peri-operative chemotherapy is the backbone of treatment for patients with osteosarcoma. Methotrexate, cisplatinum, doxorubicin and ifosfamide are the main drugs used in chemotherapy regimens used for osteosarcoma.

Areas covered: We have reviewed here the relevant literature related to the incidence and management of acute and late toxicities of systemic treatment used for the management of patients with osteosarcoma.

Expert opinion: Early diagnosis and appropriate management of acute and late toxicities of chemotherapy is crucial for an efficient care of osteosarcoma patients. Although the incidence and management of chemotherapy-related acute toxicities are well known by most oncologists, the use of high doses of methotrexate have the potential to cause fatal toxicities and, therefore, needs careful monitoring. Moreover, the diagnosis of late toxicities is more challenging and requires long-term follow-up for an appropriate management.

KEYWORDS:

• Osteosarcoma
• chemotherapy
• safety
• methotreaxta
• cisplatinum
• doxorubicin
• ifosfamide

Declaration of interest

A Italiano has received research grants from AstraZeneca, Bayer, Epizyme, Merck, MSD, Novartis and Pharmamar. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Article highlights

• Acute toxicities of cytotoxic agents used for osteosarcoma therapy include alopecia, myelosuppression, mucositis, and nausea and vomiting which are common complications of most cytotoxic chemotherapy regimens

• The use of high doses of methotrexate have the potential to cause fatal toxicities and, therefore, needs careful monitoring.

• Late toxicities of osteosarcoma chemotherapy include cardiac toxicity, acute and chronic nephrotoxicity, neurotoxicity, hearing loss, infertility, and second malignant neoplasms.

• Reducing the adverse events of osteosarcoma therapy is an important objective that will require the identification of predictive factors.

This box summarizes key points contained in the article.

Additional information

Funding

This paper was not funded.