The first 60 days: Osteosarcoma
Osteosarcoma is the most common bone cancer, mostly in teenagers. Chemotherapy plus surgery cures about two-thirds when it has not spread; because no new drug has beaten that chemotherapy in a large trial in 30 years, the next gains are being sought in cellular therapy against GD2, HER2 and B7-H3. Below, week by week, is what OnCo's record of Osteosarcoma says about the first two months: the order is typical, the timing is yours to ask about. Sections appear only where the record has something to say. Orientation, not medical advice.
What happens now
Staging tests establish exactly what and where the cancer is. Everything else follows from the answers.
- Metastatic at diagnosisNCCN category Category 2A, NCCN Guidelines: Bone Cancer
Same chemotherapy with resection of all metastases (thoracotomy) when feasible; survival ~25-30%.
Ask which of these were tested and what the results were; see the report reader for what each value means.
These specialties appear in the standard of care for this cancer. In most centres they meet weekly as a tumour board to agree each plan; you can ask when yours was discussed and what was decided.
- SurgeonNamed in the standard of care for: Localised high-grade, Metastatic at diagnosis, Relapsed.
- Medical oncologistNamed in the standard of care for: Localised high-grade, Metastatic at diagnosis, Relapsed, Unresectable / axial.
- Clinical oncologist (radiotherapy)Named in the standard of care for: Unresectable / axial.
- Transplant and cell therapy teamNamed in the standard of care for: Metastatic at diagnosis, Relapsed.
- Palliative and supportive care teamNamed in the standard of care for: Localised high-grade, Metastatic at diagnosis.
A second opinion from a centre that treats many similar cases is normal, not rude; the standard of care tells you what to compare it against.
Each row is a setting from the standard of care, in the order it usually arises. Not all will apply to you; your stage and biomarkers decide which do. The guideline grade, where recorded, says how strong the evidence is.
Neoadjuvant MAP (methotrexate, doxorubicin, cisplatin) ×2 cycles, limb-salvage resection with wide margins (amputation if required), adjuvant MAP to ~29 weeks; mifamurtide added in EU.
Carbon-ion or proton radiotherapy for craniofacial and pelvic tumours; Sm-153 or Ra-223 for bone-forming metastases (investigational).
Surgical resection of recurrence; ifosfamide ± etoposide, gemcitabine-docetaxel; regorafenib or cabozantinib; clinical trials (CAR-T, ADCs).
Generated from this cancer's standard of care, biomarkers and open problems. Take the group that matches where you are. To tick, add your own and print, open the one-page appointment sheet.
Newly diagnosed
- What is my exact diagnosis, stage, and grade, and which tests established them?Everything else follows from an accurate stage and subtype.
- Which biomarkers have been tested on my tumour (for example Histologic necrosis after neoadjuvant chemotherapy, Alkaline phosphatase and LDH, Metastases at diagnosis, Germline TP53 / RB1 / RECQL4, GD2, HER2, B7-H3 expression), and what were the results?These results decide eligibility for targeted therapy, immunotherapy, and trials.
- Which subtype is my cancer, and does that change the recommended treatment?Recognised subtypes for this cancer include Conventional high-grade, Telangiectatic, Small cell.
- Is germline (inherited) genetic testing recommended for me or my family?Inherited variants can change treatment and matter for relatives.
Localised high-grade
- For my situation (localised high-grade), which of the standard options do you recommend and why?Guideline options include: Neoadjuvant MAP (methotrexate, doxorubicin, cisplatin) ×2 cycles, limb-salvage resection with wide margins (amputation if required), adjuvant MAP to ~29 weeks; mifamurtide added in EU.
- Am I a candidate for Methotrexate, Doxorubicin, Cisplatin or related drugs, and what side effects should I expect?Knowing the expected toxicities helps you plan work, family, and supportive care.
Metastatic at diagnosis
- For my situation (metastatic at diagnosis), which of the standard options do you recommend and why?Guideline options include: Same chemotherapy with resection of all metastases (thoracotomy) when feasible; survival ~25-30%.
- Am I a candidate for Methotrexate, Doxorubicin, Cisplatin or related drugs, and what side effects should I expect?Knowing the expected toxicities helps you plan work, family, and supportive care.
Relapsed
- For my situation (relapsed), which of the standard options do you recommend and why?Guideline options include: Surgical resection of recurrence; ifosfamide ± etoposide, gemcitabine-docetaxel; regorafenib or cabozantinib; clinical trials (CAR-T, ADCs).
- Am I a candidate for Ifosfamide, Etoposide, Regorafenib or related drugs, and what side effects should I expect?Knowing the expected toxicities helps you plan work, family, and supportive care.
Unresectable / axial
- For my situation (unresectable / axial), which of the standard options do you recommend and why?Guideline options include: Carbon-ion or proton radiotherapy for craniofacial and pelvic tumours; Sm-153 or Ra-223 for bone-forming metastases (investigational).
- Am I a candidate for Radium-223 dichloride, and what side effects should I expect?Knowing the expected toxicities helps you plan work, family, and supportive care.
Any stage
- Are there clinical trials I could join, for example of Regorafenib, Cabozantinib, CAR-T cell therapy, Radium-223 dichloride?Trials are how the next standard of care is set; asking early keeps options open.
- Would a second opinion at a high-volume centre change anything, and can you help arrange it?Rare or high-stakes decisions benefit from a centre that treats many similar patients.
- What supportive care (symptom control, nutrition, exercise, mental health, financial help) is available from the start?Supportive care improves quality of life and helps patients complete treatment.
- I read that “No survival improvement since the 1980s; metastatic and relapsed disease ~20-30% survival”. How does that affect my plan?Open problems are where trials and second opinions matter most.
- I read that “No recurrent druggable driver; genomic chaos”. How does that affect my plan?Open problems are where trials and second opinions matter most.
Trials open now for this cancer in OnCo, largest phase first. Joining a trial is a decision like any other: ask what the comparison arm is, whether a placebo is used, and what happens if you leave. The cancer page searches ClinicalTrials.gov live for more.
- Study of HS-20093 Versus Gemcitabine in Combination With Docetaxel in Treatment of Osteosarcoma After Previous Second-line Treatment FailurePhase 3 · active · NCT06935409A Randomized, Controlled, Open-label, Multicenter Phase III Clinical Study to Evaluate the Efficacy and Safety of HS-20093 for Injection Versus Gemcitabine in Combination With Docetaxel in the Treatment of Osteosarcoma After Previous Second-line Treatment Failure (ARTEMIS-011)
- ARTEMIS-002: HS-20093 in Patients With Relapsed or Refractory Osteosarcoma and Other SarcomasPhase 2 · recruiting · NCT05830123ARTEMIS-002: A Phase 2, Multicenter, Open-label Study of Intravenous Administration of HS-20093 in Patients With Relapsed or Refractory Osteosarcoma and Other Sarcomas
- A Study of Cobolimab Plus Dostarlimab in Pediatric and Young Adult Participants With CancerPhase 1/2 · active · NCT06521567Phase 1/2 Dose Determination and Dose Expansion Study of Cobolimab in Combination With Dostarlimab in Pediatric and Young Adult Participants With Newly Diagnosed and Relapsed/Refractory Tumors (POPSTAR)
- Lu-TARGO (177Lu-TARGeted Osteosarcoma Therapy)Phase 1/2 · recruiting · NCT07357519A Phase 1/2, Multi-Center, Open-Label Study to Evaluate the Safety, Tolerability, Pharmacokinetics, -Radiation Dosimetry, and Preliminary Anti-Neoplastic Activity of LNTH-2403, a LRRC15-targeted 177Lutetium-labeled Monoclonal Antibody, in Participants With Relapsed / Refractory Osteosarcoma
- SPEARHEAD-3 Pediatric StudyPhase 1/2 · recruiting · NCT05642455A Phase 1/2 Open Label, Basket Study to Assess the Safety, Tolerability and Anti-Tumor Activity of Afamitresgene Autoleucel in Pediatric Subjects With MAGE-A4 Positive Tumors
Much of what helps in the first weeks is free if you know to ask: testing, helplines, rides and lodging, second opinions, trial travel.
- Osteosarcoma: the full pageOsteosarcoma is the most common bone cancer, mostly in teenagers. Chemotherapy plus surgery cures about two-thirds when it has not spread; because no new drug has beaten that chemotherapy in a large trial in 30 years, the next gains are being sought in cellular therapy against GD2, HER2 and B7-H3.
- One-page appointment sheetYour questions, the words you may hear, what to bring, and space for the answers. Print it.
- Treatment sequencingWhich treatment tends to follow which, line by line.
- NavigatorStandard of care for your stage, what you have tried, and trials near you.
- Limb-salvage surgery: Removing a bone or soft-tissue sarcoma while keeping the arm or leg, rebuilding the bone with a metal endoprosthesis or a graft.
- FNCLCC grade (soft-tissue sarcoma): The FNCLCC grade is a 1-to-3 score for soft-tissue sarcomas based on how abnormal, how fast-dividing, and how much dead tissue the tumour shows; grade drives whether chemotherapy is considered.
- Li-Fraumeni syndrome (germline TP53): Li-Fraumeni syndrome is an inherited fault in the TP53 gene giving a lifetime cancer risk near 100% in women and ~75% in men, with sarcomas, breast cancer, brain tumours, adrenal cancer and leukaemias often in childhood.
- Adolescent and young adult (AYA) oncology: Cancer in people aged 15-39, about 90,000 US cases a year, with a distinct mix of cancers, slower survival improvement than children or older adults, and specific needs: fertility, education and work, psychosocial support and trial access.
Every term links to the glossary.