title: Comparison of pirarubicin-based versus gemcitabine-docetaxel chemotherapy for relapsed and refractory osteosarcoma: a single institution experience.
abstract: BACKGROUND
  The prognoses for patients with relapsed and refractory osteosarcoma are poor and the optimal treatment strategy is still to be defined. We conducted this retrospective study to compare the feasibility and efficacy of pirarubicin-based chemotherapy with gemcitabine-docetaxel combination regimens for the salvage of these patients.
  
  
  METHODS
  The clinical data of 75 patients who received pirarubicin-based (n = 52) or gemcitabine-docetaxel (n = 23) chemotherapy as a second-line treatment for relapsed and refractory osteosarcoma between January 2005 and September 2011were reviewed retrospectively. Tumor response was evaluated every two chemotherapy cycles by computed tomography/magnetic resonance imaging (CT/MRI) scans using the Response Evaluation Criteria in Solid Tumors. Progression-free survival and overall survival (OS) were evaluated by Kaplan-Meier analysis. Toxicity was examined according to the National Cancer Institute Toxicity Criteria grading system.
  
  
  RESULTS
  Patient characteristics were well balanced in the two groups. The response rate was 25.0 % in patients who received pirarubicin-based chemotherapy, while it was 13.0 % in the gemcitabine-docetaxel group. Moreover, the median OS was longer in the pirarubicin-based chemotherapy group (14.0 vs. 9.0 months, P < 0.05), especially in the pirarubicin-ifosfamide (14.0 months) and pirarubicin-cisplatin (15.0 months) subgroups. The incidence of grade 3-4 neutropenia was higher in the gemcitabine-docetaxel group (5.8 vs. 43.5 %, P < 0.05); other grade 3-4 toxicities were comparable in the two groups.
  
  
  CONCLUSIONS
  In our experience, pirarubicin-based chemotherapy was comparable with gemcitabine-docetaxel as a second-line treatment for relapsed and refractory osteosarcoma, and it even seemed to show greater efficacy, with milder toxicity. Further studies, especially prospective clinical trials, focusing on pirarubicin-based treatments for relapsed and refractory osteosarcoma patients should be strongly considered.
authors.affiliation: Department of Oncology, The Sixth People's Hospital, Shanghai Jiao Tong University, Shanghai, 200233, China.
authors.forename: Aina
authors.initials: A
authors.lastname: He
authors.forename: Weixiang
authors.initials: W
authors.lastname: Qi
authors.forename: Yujing
authors.initials: Y
authors.lastname: Huang
authors.forename: Yuanjue
authors.initials: Y
authors.lastname: Sun
authors.forename: Zan
authors.initials: Z
authors.lastname: Shen
authors.forename: Hui
authors.initials: H
authors.lastname: Zhao
authors.forename: Yumei
authors.initials: Y
authors.lastname: Yang
authors.forename: Yang
authors.initials: Y
authors.lastname: Yao
mesh_terms: D000293:Adolescent; D000328:Adult; D000971:Antineoplastic Combined Chemotherapy Protocols; D001859:Bone Neoplasms / Q000188:drug therapy* / Q000473:pathology; D002648:Child; D003841:Deoxycytidine / Q000008:administration & dosage / Q000031:analogs & derivatives; D018572:Disease-Free Survival; D000077143:Docetaxel; D004317:Doxorubicin / Q000008:administration & dosage / Q000009:adverse effects / Q000031:analogs & derivatives*; D064420:Drug-Related Side Effects and Adverse Reactions / Q000145:classification / Q000473:pathology; D005260:Female; D006801:Humans; D007069:Ifosfamide / Q000008:administration & dosage*; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D012516:Osteosarcoma / Q000188:drug therapy* / Q000473:pathology; D011446:Prospective Studies; D043823:Taxoids / Q000008:administration & dosage; D000093542:Gemcitabine
chemical_list: D043823:Taxoids; D003841:Deoxycytidine; D000077143:Docetaxel; D004317:Doxorubicin; C027260:pirarubicin; D007069:Ifosfamide; D000093542:Gemcitabine