Introduction to Osteosarcoma Osteosarcoma is the most common type of bone cancer that affects both children and adults. It develops in bones, often in the arms or legs, more specifically around the knees, lower femur, and upper tibia. Osteosarcoma is an aggressive cancer that occurs when bone-forming cells (osteoblasts) mutate and grow rapidly, forming tumors around the affected areas. While it is rare, accounting for less than 1% of all cancers, osteosarcoma is the most frequent form of bone cancer, occurring most often in teenagers and young adults between 10 to 30 years of age. According to statistics from major cancer institutions, the 5-year survival rate for patients diagnosed with localized osteosarcoma is approximately 70%, but the rate drops to around 30% for patients whose cancer has metastasized or spread to other parts of the body at the time of diagnosis. Current Osteosarcoma Treatment Approaches The main treatment approaches for osteosarcoma currently involve some combination of surgery, chemotherapy, and radiation therapy. Surgery to remove the primary tumor remains a key part of osteosarcoma treatment in most cases. For cancers that have not spread beyond the bone, complete surgical removal of the affected bone offers the best chance of a cure. When possible, surgeons will perform limb-sparing surgeries to remove the tumor while saving the affected arm or leg. However, sometimes amputation is needed to fully eliminate the cancer. Besides surgery, chemotherapy is often employed both before and after tumor removal to try to eliminate any remaining cancer cells and prevent recurrence and metastasis. Common chemotherapy drugs used for osteosarcoma include cisplatin, doxorubicin, ifosfamide, and methotrexate. Radiation therapy may also be utilized either before or after surgery in some cases, such as when the tumor is too large to be fully removed or if the cancer has spread. While the current standard approaches have improved outcomes for many patients, new treatment strategies are still needed, especially for those facing recurrent or metastatic disease who have poor prognoses with traditional therapies alone. Promising new developments are investigating immunotherapies, targeted drug therapies, and novel combinations utilizing multiple treatment types. Immunotherapy uses the body's own immune system to help fight the cancer and is being studied both alone and in combination with chemotherapy or other therapies. Targeted therapies aim to specifically interfere with pathways that drive osteosarcoma growth and progression at the molecular level. Combination treatment strategies employing multiple osteosarcoma treatment modalities simultaneously hope to achieve synergistic anti-tumor effects greater than any single approach alone. Continued research advances offer hope that more effective therapies can be developed to improve outcomes for all osteosarcoma patients. Neoadjuvant Chemotherapy Neoadjuvant chemotherapy, or preoperative chemotherapy, administered before surgical resection of the primary tumor has become the standard of care for newly diagnosed osteosarcoma patients. The goal of neoadjuvant chemotherapy is to shrink the primary tumor and eliminate any potential microscopic metastases present at the time of diagnosis. By reducing the size of the tumor prior to surgery, neoadjuvant chemotherapy makes limb-sparing procedures possible in cases where amputation may otherwise have been required to fully remove the cancer. Numerous studies have clearly demonstrated the superiority of neoadjuvant chemotherapy followed by surgery compared to surgery alone. One of the earliest landmark studies found that the addition of preoperative chemotherapy nearly doubled the 5-year overall survival rate from less than 20% to over 60% with surgery alone versus surgery plus chemotherapy. Today, the most commonly used neoadjuvant chemotherapy regimen for osteosarcoma is a combination of multiple agents including doxorubicin, cisplatin, and methotrexate or ifosfamide. This multi-drug approach is administered in cycles over the course of several months to shrink and eliminate as much of the tumor as possible before surgical removal of any remaining cancer. Researchers are continuing to evaluate new drug combinations and sequencing strategies as part of neoadjuvant protocols in hopes of further improving response rates and long-term outcomes. Elucidating mechanisms of chemoresistance is also an active area of study to overcome limitations of current therapies and enhance treatment effectiveness. Overall, neoadjuvant chemotherapy has clearly established itself as the first line of osteosarcoma treatment in helping to control primary osteosarcoma tumors before definitive surgery. Adjuvant Chemotherapy and Relapse Prevention After surgical resection of the primary osteosarcoma tumor, adjuvant chemotherapy is commonly prescribed to eliminate any remaining microscopic disease and reduce the risk of future recurrence or metastasis. Many studies have demonstrated that the addition of postoperative chemotherapy significantly lowers relapse rates compared to surgery alone. Similar multidrug regimens containing cisplatin, doxorubicin, and high-dose methotrexate are generally employed as adjuvant treatment. The timing and duration of adjuvant chemotherapy after surgery still requires further elucidation, but most regimens involve administering 3-4 post-op cycles of chemotherapy over 6-12 months. Proper administration of adjuvant chemotherapy is crucial since the majority of relapses occur within the first 3 years after diagnosis. Relapse or metastatic spread remains the main cause of treatment failure for osteosarcoma treatment despite current multi-modal therapies. Novel approaches are investigating more dose-intensive regimens and new drug combinations as part of adjuvant protocols. Careful monitoring for recurrence with frequent imaging and serum tumor marker testing is also important to potentially identify relapse at an early, most treatable stage. Additional areas of focus involve identifying novel prognostic and predictive biomarkers to guide risk stratification and tailor adjuvant approaches. Immunotherapies that activate the immune system against cancer cells offer promising opportunities both to eliminate residual disease and prevent future relapse when combined with standard chemotherapy. Overall, continuous refinement of adjuvant protocols seeks to further minimize osteosarcoma recurrence through optimized relapse prevention therapies. Targeted Therapies and Personalized Medicine Advances in understanding the molecular underpinnings of osteosarcoma malignancy have ushered in an era of targeted therapy development. Specific genetic changes and signaling pathways dysregulated in osteosarcoma are being exploited as novel therapeutic targets. For example, about 15-20% of high-grade osteosarcomas exhibit non-random translocations involving the retinoblastoma gene which play a key role in driving tumor development and growth. Agents targeting downstream effectors of the retinoblastoma pathway such as ribociclib are showing promise in early clinical trials. Similarly, inhibitors targeting other common osteosarcoma-associated genetic alterations like MET, IDH1/2, RB1, and p53 abnormalities are in early testing. A major focus is also placed on targeting oversecreted growth factors and their receptors implicated in promoting the hallmarks of osteosarcoma malignancy. Drugs blocking vascular endothelial growth factor (VEGF) signaling which supports tumor angiogenesis have demonstrated some benefit. Inhibitors of other receptor tyrosine kinases aberrantly stimulated in osteosarcoma such as EGFR, IGF1R, FGFR, are also being evaluated clinically.
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*Note: 1. Source: Coherent Market Insights, Public sources, Desk research 2. We have leveraged AI tools to mine information and compile it
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Osteosarcoma most often occurs in the long bones that make up the arms and legs, although it can occur in any bone.
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Osteosarcoma Global Clinical Trials Review, H1, 2020 Summary Researcher clinical trial report, “Osteosarcoma Global Clinical Trials Review, H1, 2020" provides an overview of Osteosarcoma Clinical trials scenario.
This report provides top line data relating to the clinical trials on Osteosarcoma.
The report offers coverage of disease clinical trials by region, country (G7 & E7), phase, trial status, end points status and sponsor type.
Report also provides prominent drugs for in-progress trials (based on number of ongoing trials).
GlobalData Clinical Trial Reports are generated using proprietary database - Pharma eTrack Clinical trials database.
Clinical trials database undergoes periodic update by dynamic process.
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