Osteosarcoma

The current dilemma in osteosarcoma management surrounds the role of a novel biological agent, liposomal muramyl tripeptide phosphatidyl ethanolamine (L-MTP-PE, mifurmatide). Interest in L-MTP-PE was initially generated as preclinical data demonstrated responses in metastatic pulmonary osteosarcoma in animal models. A large phase III randomized trial was conducted by the Pediatric Oncology Group (POG)/Children's Oncology Group (COG) in the US to provide evidence of efficacy. The interpretation of the published reports of the study has, however, caused controversy. The context is that prior to these publications, there has been no significant improvement in survival for patients with osteosarcoma during the last two decades. Does adjuvant use of L-MTP-PE represent a breakthrough? Before addressing this question, the chapter discusses progress in osteosarcoma management to date. It provides a summary of previous studies and presents three new studies. © 2013 John Wiley & Sons, Ltd.