Osteosarcoma

Background

Osteosarcoma is an aggressive primary bone tumour, typical of the paediatric age. The standard treatment involves the surgical resection of the tumour supported by cycles of adjuvant and neo-adjuvant chemotherapy. To date, the effect on survival outcomes of different combinations of cytotoxic drugs, drug dosages and time to complete chemotherapy regimens is still unknown. 

Due to toxicity, reductions in cytotoxic drug dosage and increased time to complete the regimen, the received dose-intensity is typically 20-30% lower than intended. However, the effect of reduced received dose-intensity on survival has not been well-established yet.

Novelty

Aim of this research is to develop proper methodology to investigate the effect of received dose-intensity on survival by using a large cohort of osteosarcoma patients who were treated with neo-adjuvant chemotherapy in randomized and non-randomized studies from 6 osteosarcoma European study groups.

Relevance for cancer research

This research aims to calculate the received dose-intensity and relate them to survival outcomes. It is of clinical importance to look at toxicity in order to determine an optimal treatment regimen for osteosarcoma by using conventional drugs. Results from this study will give more insight into the most appropriate use of conventional drugs and will provide guidelines for osteosarcoma treatment. For children it is crucial that the most efficient drugs are given at dose levels which correspond to the cure with as little as possible side effects on short and long term. Because of their expected long-lifetime after successful treatment, serious side effects need to be reduced as much as possible.

Project Outcomes

• Lancia C, Anninga JK, Sydes MR, Spitoni C, Whelan J, Hogendoorn PCW, Gelderblom H & Fiocco M (2019). Method to measure the mismatch between target and achieved received dose intensity of chemotherapy in cancer trials: a retrospective analysis of the MRC BO06 trial in osteosarcoma. BMJ Open 9(5). doi: 10.1136/bmjopen-2018-022980 

• Lancia C, Anninga JK, Sydes MR, Spitoni C, Whelan J, Hogendoorn PCW, Gelderblom H & Fiocco M (2019). A novel method to address the association between received dose intensity and survival outcome: benefits of approaching treatment intensification at a more individualised level in a trial of the European Osteosarcoma Intergroup. Cancer chemotherapy and pharmacology 83(5), 951-962. doi: 10.1007/s00280-019-03797-3 

• Lancia C, Spitoni C, Anninga J, Whelan J, Sydes MR, Jovic G & Fiocco M (2019). Marginal structural models with dose-delay joint-exposure for assessing variations to chemotherapy intensity. Statistical Methods in Medical Research 28(9):2787-2801. doi: 10.1177/0962280218780619

Team

• Dr.  J.K. Anninga (PI), MD, Radboudumc Amalia Children's Hospital 

• Dr. M. Fiocco (PI), Mathematical Institute Leiden University, Department of Biomedical Data Sciences Leiden University Medical Center & Princess Máxima Center for Pediatric Oncology 

• Dr. ir. C. Lancia, Mathematical Institute Leiden University