title: Osteosarcoma: the addition of muramyl tripeptide to chemotherapy improves overall survival--a report from the Children's Oncology Group.
abstract: OBJECTIVE
  To compare three-drug chemotherapy with cisplatin, doxorubicin, and methotrexate with four-drug chemotherapy with cisplatin, doxorubicin, methotrexate, and ifosfamide for the treatment of osteosarcoma. To determine whether the addition of muramyl tripeptide (MTP) to chemotherapy enhances event-free survival (EFS) and overall survival in newly diagnosed patients with osteosarcoma.
  
  
  METHODS
  Six hundred sixty-two patients with osteosarcoma without clinically detectable metastatic disease and whose disease was considered resectable received one of four prospectively randomized treatments. All patients received identical cumulative doses of cisplatin, doxorubicin, and methotrexate and underwent definitive surgical resection of primary tumor. Patients were randomly assigned to receive or not to receive ifosfamide and/or MTP in a 2 x 2 factorial design. The primary end points for analysis were EFS and overall survival.
  
  
  RESULTS
  In the current analysis, there was no evidence of interaction, and we were able to examine each intervention separately. The chemotherapy regimens resulted in similar EFS and overall survival. There was a trend toward better EFS with the addition of MTP (P = .08). The addition of MTP to chemotherapy improved 6-year overall survival from 70% to 78% (P = .03). The hazard ratio for overall survival with the addition of MTP was 0.71 (95% CI, 0.52 to 0.96).
  
  
  CONCLUSIONS
  The addition of ifosfamide to cisplatin, doxorubicin, and methotrexate did not enhance EFS or overall survival for patients with osteosarcoma. The addition of MTP to chemotherapy resulted in a statistically significant improvement in overall survival and a trend toward better EFS.
authors.affiliation: Children's Oncology Group, Arcadia, CA, USA. meyersp@mskcc.org
authors.forename: Paul A
authors.initials: PA
authors.lastname: Meyers
authors.forename: Cindy L
authors.initials: CL
authors.lastname: Schwartz
authors.forename: Mark D
authors.initials: MD
authors.lastname: Krailo
authors.forename: John H
authors.initials: JH
authors.lastname: Healey
authors.forename: Mark L
authors.initials: ML
authors.lastname: Bernstein
authors.forename: Donna
authors.initials: D
authors.lastname: Betcher
authors.forename: William S
authors.initials: WS
authors.lastname: Ferguson
authors.forename: Mark C
authors.initials: MC
authors.lastname: Gebhardt
authors.forename: Allen M
authors.initials: AM
authors.lastname: Goorin
authors.forename: Michael
authors.initials: M
authors.lastname: Harris
authors.forename: Eugenie
authors.initials: E
authors.lastname: Kleinerman
authors.forename: Michael P
authors.initials: MP
authors.lastname: Link
authors.forename: Helen
authors.initials: H
authors.lastname: Nadel
authors.forename: Michael
authors.initials: M
authors.lastname: Nieder
authors.forename: Gene P
authors.initials: GP
authors.lastname: Siegal
authors.forename: Michael A
authors.initials: MA
authors.lastname: Weiner
authors.forename: Robert J
authors.initials: RJ
authors.lastname: Wells
authors.forename: Richard B
authors.initials: RB
authors.lastname: Womer
authors.forename: Holcombe E
authors.initials: HE
authors.lastname: Grier
mesh_terms: D000293:Adolescent; D000328:Adult; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D001859:Bone Neoplasms / Q000188:drug therapy* / Q000401:mortality*; D002648:Child; D002675:Child, Preschool; D002945:Cisplatin / Q000008:administration & dosage; D018572:Disease-Free Survival; D004317:Doxorubicin / Q000008:administration & dosage; D005260:Female; D006801:Humans; D007069:Ifosfamide / Q000008:administration & dosage*; D007223:Infant; D008175:Lung Neoplasms / Q000556:secondary; D008297:Male; D008727:Methotrexate / Q000008:administration & dosage; D009364:Neoplasm Recurrence, Local; D012516:Osteosarcoma / Q000188:drug therapy* / Q000401:mortality* / Q000556:secondary; D015996:Survival Rate
chemical_list: D004317:Doxorubicin; D002945:Cisplatin; D007069:Ifosfamide; D008727:Methotrexate