Transfer of complex frontline anticancer therapy to a developing country: the St. Jude osteosarcoma experience in Chile.
BACKGROUND
A frontline protocol for newly diagnosed osteosarcoma was conducted simultaneously at St. Jude Children's Research Hospital (sponsor) and Calvo Mackenna Hospital (CMH, partner), a public pediatric hospital and national center for the treatment of bone tumors in Santiago, Chile.


METHODS
Of 72 eligible patients, 22 (31%) were enrolled and managed in Santiago, without travel to Memphis. Pathology specimens and imaging material were centrally reviewed at St. Jude. Patients received 12 intensive courses of systemic chemotherapy with hematopoietic growth factor support over 35 weeks, and amputation or limb-salvage surgery as indicated for local control. The sponsor assisted the partner site to establish a clinical research infrastructure and obtain hematopoietic growth factor. Communication among medical and nursing teams was maintained throughout the study. Patient-care and protocol issues were discussed frequently between the two centers via scheduled videoconferences and electronic communications. Auditors monitored appropriate study conduct at the international site.


RESULTS
No major discrepancies were identified in histologic findings, staging, or imaging studies. Preliminary results demonstrated similar outcome and treatment tolerance; the 2-year event-free survival estimate was 78.5% (95% CI, 51-100%) for patients treated at CMH (median follow-up, 1.6 years) and 74.3% (95% CI, 62-87%) for patients treated at St. Jude (median follow-up, 4 years). Overall per-patient costs were significantly lower in Chile.


CONCLUSIONS
Through a twinning mechanism, it is feasible to simultaneously conduct complex front-line osteosarcoma clinical trials at two institutions in countries with different levels of resources.
Rivera
Gaston K
GK
International Outreach Program, St. Jude Children's Research Hospital, Memphis, Tennessee, USA. gaston.rivera@stjude.org
Quintana
Juan
J
Villarroel
Milena
M
Santana
Victor M
VM
Rodriguez-Galindo
Carlos
C
Neel
Michael D
MD
Velez
George
G
Ribeiro
Raul C
RC
Daw
Najat C
NC
D001859:Bone Neoplasms / Q000628:therapy*; D002648:Child; D002677:Chile; D003906:Developing Countries; D006776:Hospitals, Pediatric; D006801:Humans; D007391:International Cooperation; D012516:Osteosarcoma / Q000628:therapy*; D013714:Tennessee