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document
Osteosarcoma : the addition of muramyl tripeptide to chemotherapy improves overall survival -- a report from the Children 's Oncology Group . PURPOSE To compare three-drug chemotherapy with cisplatin , doxorubicin , and methotrexate with four-drug chemotherapy with cisplatin , doxorubicin , methotrexate , and ifosfamide for the treatment of osteosarcoma . To determine whether the addition of muramyl tripeptide ( MTP ) to chemotherapy enhances event-free survival ( EFS ) and overall survival in newly diagnosed patients with osteosarcoma . PATIENTS AND METHODS Six hundred sixty-two patients with osteosarcoma without clinically detectable metastatic disease and whose disease was considered resectable received one of four prospectively randomized treatments . All patients received identical cumulative doses of cisplatin , doxorubicin , and methotrexate and underwent definitive surgical resection of primary tumor . Patients were randomly assigned to receive or not to receive ifosfamide and/or MTP in a 2 x 2 factorial design . The primary end points for analysis were EFS and overall survival . RESULTS In the current analysis , there was no evidence of interaction , and we were able to examine each intervention separately . The chemotherapy regimens resulted in similar EFS and overall survival . There was a trend toward better EFS with the addition of MTP ( P = .08 ) . The addition of MTP to chemotherapy improved 6-year overall survival from 70 % to 78 % ( P = .03 ) . The hazard ratio for overall survival with the addition of MTP was 0.71 ( 95 % CI , 0.52 to 0.96 ) . CONCLUSION The addition of ifosfamide to cisplatin , doxorubicin , and methotrexate did not enhance EFS or overall survival for patients with osteosarcoma . The addition of MTP to chemotherapy resulted in a statistically significant improvement in overall survival and a trend toward better EFS .
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Intervention_Pharmacological
muramyl tripeptide
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Intervention_Pharmacological
cisplatin , doxorubicin , and methotrexate
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Intervention_Pharmacological
four-drug chemotherapy with cisplatin , doxorubicin , methotrexate , and ifosfamide
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Intervention_Pharmacological
muramyl tripeptide ( MTP )
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Intervention_Pharmacological
cisplatin , doxorubicin , and methotrexate
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Intervention_Pharmacological
receive ifosfamide and/or MTP
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Outcome_Mortality
overall survival -- a
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Outcome_Mortality
event-free survival ( EFS ) and overall survival
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Outcome_Mortality
EFS and overall survival
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Outcome_Mortality
EFS and overall survival
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Outcome_Mortality
EFS
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Outcome_Mortality
6-year overall survival
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Outcome_Mortality
hazard ratio for overall survival
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Outcome_Mortality
EFS
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Outcome_Mortality
overall survival
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Outcome_Mortality
overall survival
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Outcome_Mortality
EFS
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Participant_Age
Children 's
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Participant_Sample-size
Six hundred sixty-two
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Participant_Condition
osteosarcoma