Maximum benefit of chemotherapy for osteosarcoma achieved—what are the next steps?

The survival rates for osteosarcoma have remained stagnant at 60–65% for more than 25 years. The three-drug chemotherapy regimen of cisplatin, doxorubicin, and methotrexate (MAP) form the backbone therapy, and response to induction chemotherapy correlates with patient outcome.1 Debate remains about the usefulness of adding dose-intensive ifosphamide with or without etoposide to the three-drug MAP regimen (MAPIE) to improve the outcome of patients with a poor response (defined as ≤90% tumour necrosis) to induction chemotherapy.