“Evolution of Novel, Low Cost, Sustainable Osteosarcoma Care over Two Decades: Reducing Inefficiencies, & Improving Outcomes”

Date 22 October 2018
Event ESMO 2018 Congress
Session Poster display session: Breast cancer - early stage, locally advanced & metastatic, CNS tumours, Developmental therapeutics, Genitourinary tumours - prostate & non-prostate, Palliative care, Psycho-oncology, Public health policy, Sarcoma, Supportive care
Topics Bone Sarcomas
Bioethics, Legal, and Economic Issues
Presenter Jyoti Bajpai
Citation Annals of Oncology (2018) 29 (suppl_8): viii576-viii595. 10.1093/annonc/mdy299
Authors J. Bajpai1, T. Mondal1, V. Simha1, A. Chandrashekharan1, S. Hingmire2, B. Rangarajan3, N. Shetty1, K. Shah1, R. Dusane4, B. Rekhi1, T.S. Vora1, J. Ghosh1, S. Banavali1, S. Gupta1
  • 1Medical Oncology, Tata Memorial Hospital Centre, 400012 - Mumbai/IN
  • 2Medical Oncology, Deenanath Mangeshkar Hospital & Research Centre, 411004 - Pune/IN
  • 3Medical Oncology, KMCH Comprehensive Cancer Centre, 641014 - Coimbatore/IN
  • 4Biostatistics, Tata Memorial Hospital Centre, 400012 - Mumbai/IN

Abstract

Background

Osteosarcoma care is challenging especially in lower and middle income countries with limited resources & increasing patient volumes. We need to reduce inefficient practices &reallocate resources to strategies, which can make the greatest &sustainable improvements in patient care.

Methods

We compared the outcomes in non-metastatic osteosarcoma patients treated with 3 sequential non-HDMTX based combination chemotherapy protocols at a single tertiary care center in India over 2 decades. The 1st protocol “OGS-99”, involved dose-intense, alternating doublets of, 4 drugs, doxorubicin(Dox),cisplatin(CDDP),ifosfamide(Ifo) & etoposide(Eto); the 2nd protocol, “OGS-99-enhanced”, involved OGS-99 drugs with enhanced supportive care including growth factors. The 3 rd dose-dense , “OGS-12” protocol, involved administration of 8 sequential doublets of the 3 most active drugs,(Dox, Cis & Ifo), universal growth factor prophylaxis & targeted nutritional support including IV Iron if required . Event free survival (EFS), overall survivals (OS) and toxicity were estimated using retrospective chart review in OGS-99 & OGS-99-enhanced protocols & prospectively in OGS-12 protocol.

Results

A total of 41, 94 & 385 treatment naive, consecutive, non-metastatic,extremity patients were treated with OGS-99(year 2000-2005), OGS-99-enhanced (2010) & OGS-12 (2011-2016) respectively. At a median follow-up of 19(3-72), 85(2-99) and 36(6-78) months, the 5 year EFS rates are 36%, 50% and 69% in OGS-99, OGS enhanced & in OGS-12 respectively. The corresponding rates of 5 year OS are non-evaluable, 60% & 83% respectively. OGS-12 protocol fared better with respect to grade ¾ toxicities; febrile neutropenia (40%), thrombocytopenia (36%), anaemia (51%) with 4(1%) chemo toxic deaths & compliance to therapy.

Conclusions

Sequential adaption of more rational chemotherapy regimens, including conception of novel "OGS-12" protocol with, better dose density and elimination of ineffective drugs, enhanced supportive care & thereby reducing the need for dose reductions, resulted in marked improvement in outcomes of non-metastatic osteosarcoma patients. This sustainable, economic efficient strategy is worthy of wide adaption.

Clinical trial identification

Legal entity responsible for the study

Jyoti Bajpai.

Funding

Has not received any funding.

Editorial Acknowledgement

Disclosure

All authors have declared no conflicts of interest.