Experience of using neoadjuvant three-component chemotherapy (cisplatin, doxorubicin, methotrexate) in young adults with osteosarcoma

Introduction. Modern treatment of osteosarcoma requires multicomponent therapy including pre-surgery chemotherapy. The benefits of such therapy are in vivo evaluation of chemotherapy drug activity and creation of conditions for more effective surgical intervention.

Aim. To analyze the effectiveness of three-component chemotherapy based on a combination of doxorubicin, cisplatin and methotrexate in young adults with osteosarcoma.

Materials and methods. Between 2022 and 2024, 22 patients between the ages of 18 and 42 years (mean age 30 years) with malignant tumors of the bones received treatment at the N.N. Blokhin National Medical Research Center of Oncology. Before the start of chemotherapy, all patients underwent morphological and clinical imaging examinations. The patients received 2 courses of neoadjuvant chemotherapy (doxorubicin + cisplatin + methotrexate) with subsequent surgical treatment stage.

Results. Sixteen patients fully completed neoadjuvant polychemotherapy and local control stage, 12 of them received 2 courses of MAP (doxorubicin + cisplatin + methotrexate) chemotherapy. Complete response was not observed. Stable disease was registered in 1 (8.3 %) patient, partial response in 8 (66.6 %) patients. Tumor control was achieved in 74.9 % of patients. In 3 cases, disease progression was observed. Surgical treatment was performed in 10 (83.3 %) cases, among them 9 (75 %) interventions were organ-sparing. One patient refused surgical treatment and received radical external beam radiotherapy. In 1 (8.3 %) case grade IV therapeutic pathomorphosis was observed, in 3 (25 %) – grade III, in 3 (25 %) – grade II, in 3 (25 %) – grade I, in 2 (16.7 %) cases it was not registerable (disease progression was observed).

Conclusion. During our study we achieved high level of tumor control (74.9 % of cases) but grade III–IV therapeutic pathomorphosis was achieved only in 33.3 % cases. According to our data, peak methotrexate concentration does not affect therapy effectiveness. In the future, it is necessary to include more patients in the study group, analyze recurrence-free and overall survival and compare MAP chemotherapy with standard regimen chemotherapy (cisplatin+ doxorubicin).