title: Inhaled granulocyte-macrophage colony stimulating factor for first pulmonary recurrence of osteosarcoma: effects on disease-free survival and immunomodulation. a report from the Children's Oncology Group.
abstract: OBJECTIVE
  Osteosarcoma most commonly recurs in the lung. Based on preliminary data on the antitumor effects of granulocyte-macrophage colony stimulating factor (GM-CSF) in animal models, and promising phase I trials, we embarked on a feasibility study of inhaled GM-CSF in patients with first isolated pulmonary recurrence of osteosarcoma.
  
  
  METHODS
  Forty-three eligible patients received inhaled GM-CSF at doses from 250 to 1,750 microg twice daily on alternate weeks. Following two cycles, patients underwent thoracotomy to resect tumor and analyze pulmonary nodules for expression of Fas/Fas ligand (Fas/FasL), and the presence of dendritic cells by immunostaining for CD1a, clusterin, and S100. Following surgery, patients received 12 additional cycles of therapy on alternating weeks or until progression. Event-free survival and survival, and feasibility of therapy delivery were evaluated.
  
  
  RESULTS
  Dose escalation to 1,750 microg twice daily was feasible with no dose-limiting toxicity. Mean scores for Fas/FasL in nodules from patients with bilateral recurrence who underwent unilateral thoracotomy pretreatment (using a scoring system of 0-3) were 1.3 and 0.88, respectively, compared with 0.78 and 0.62 in nodules resected following two cycles of therapy. Only 11 of 30 nodules postinhalation were positive for CD1a, 4 of 30 for S100, and 6 of 30 for clusterin. Event-free and overall survival at 3 years were 7.8% and 35.4%, respectively.
  
  
  CONCLUSIONS
  Inhalation of GM-CSF at doses from 250 to 1,750 microg twice daily on alternate weeks was feasible with low toxicity. However, no detectable immunostimulatory effect in pulmonary metastases or improved outcome postrelapse was seen.
authors.affiliation: Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA. carndt@mayo.edu
authors.forename: Carola A S
authors.initials: CA
authors.lastname: Arndt
authors.forename: Nadya V
authors.initials: NV
authors.lastname: Koshkina
authors.forename: Carrie Y
authors.initials: CY
authors.lastname: Inwards
authors.forename: Douglas S
authors.initials: DS
authors.lastname: Hawkins
authors.forename: Mark D
authors.initials: MD
authors.lastname: Krailo
authors.forename: Doojduen
authors.initials: D
authors.lastname: Villaluna
authors.forename: Peter M
authors.initials: PM
authors.lastname: Anderson
authors.forename: Allen M
authors.initials: AM
authors.lastname: Goorin
authors.forename: Martin L
authors.initials: ML
authors.lastname: Blakely
authors.forename: Mark
authors.initials: M
authors.lastname: Bernstein
authors.forename: Sharon A
authors.initials: SA
authors.lastname: Bell
authors.forename: Kaylee
authors.initials: K
authors.lastname: Ray
authors.forename: Darryl C
authors.initials: DC
authors.lastname: Grendahl
authors.forename: Neyssa
authors.initials: N
authors.lastname: Marina
authors.forename: Eugenie S
authors.initials: ES
authors.lastname: Kleinerman
mesh_terms: D000280:Administration, Inhalation; D000293:Adolescent; D000328:Adult; D000970:Antineoplastic Agents / Q000008:administration & dosage*; D001859:Bone Neoplasms / Q000188:drug therapy* / Q000401:mortality / Q000473:pathology; D002648:Child; D018572:Disease-Free Survival; D005240:Feasibility Studies; D005260:Female; D016178:Granulocyte-Macrophage Colony-Stimulating Factor / Q000008:administration & dosage*; D006801:Humans; D056747:Immunomodulation / Q000187:drug effects*; D053208:Kaplan-Meier Estimate; D008175:Lung Neoplasms / Q000188:drug therapy* / Q000401:mortality / Q000556:secondary; D008297:Male; D012516:Osteosarcoma / Q000188:drug therapy* / Q000401:mortality / Q000473:pathology; D055815:Young Adult
chemical_list: D000970:Antineoplastic Agents; D016178:Granulocyte-Macrophage Colony-Stimulating Factor