RATIONALE: Drugs used in chemotherapy, such as cisplatin, doxorubicin, and methotrexate, work in different ways to stop tumor cells from dividing so they stop growing or die. Combining pamidronate with chemotherapy may prevent bone metastases and reduce the chance of bone replacement problems by strengthening bones in patients who are undergoing surgery for osteosarcoma.

PURPOSE: Phase II trial to study the effectiveness of combining neoadjuvant and adjuvant pamidronate with induction and maintenance chemotherapy in treating patients who have newly diagnosed osteosarcoma.

Condition	Treatment or Intervention	Phase
localized osteosarcoma metastatic osteosarcoma	Drug: cisplatin  Drug: doxorubicin  Drug: methotrexate  Drug: pamidronate  Procedure: adjuvant therapy  Procedure: bone metastases prevention  Procedure: chemotherapy  Procedure: conventional surgery  Procedure: high-dose chemotherapy  Procedure: hypercalcemia therapy  Procedure: neoadjuvant therapy  Procedure: supportive care/therapy  Procedure: surgery	Phase II

Further Study Details: 

OBJECTIVES:

• Determine the safety and feasibility of pamidronate with standard induction and maintenance chemotherapy in patients with newly diagnosed high-grade osteosarcoma.
• Determine the frequency of favorable tumor necrosis produced in patients treated with this regimen.
• Determine the event-free survival of patients without metastatic disease at presentation treated with this regimen.
• Determine the prosthesis failure-free survival of patients treated with this regimen and who ultimately undergo limb preservation surgery with insertion of an endoprosthesis.

OUTLINE: Patients are stratified according to extent of disease (localized vs metastatic).

• Induction therapy: Patients receive standard chemotherapy comprising cisplatin IV over 4 hours and doxorubicin IV over 15-30 minutes on weeks 0 and 5 and high-dose methotrexate IV over 4 hours on weeks 3, 4, 8, and 9. Patients also receive pamidronate IV over 2-4 hours beginning approximately 3 days after initiation of chemotherapy on week 0 and repeating once every 4 weeks. Treatment continues in the absence of disease progression or unacceptable toxicity.
• Surgery*: Patients undergo surgical resection of primary tumor on week 10 and then proceed to maintenance therapy. Patients with metastatic disease undergo further surgery of metastatic sites after recovery from definitive resection of the primary tumor before proceeding to maintenance therapy. NOTE: *Patients who have undergone definitive surgical resection before study entry may proceed to maintenance therapy or, if appropriate, surgical resection of metastatic disease
• Maintenance therapy: Patients receive standard chemotherapy comprising cisplatin IV over 4 hours on weeks 0 and 5; doxorubicin IV over 15-30 minutes on weeks 0, 5, 10, and 15; and high-dose methotrexate IV over 4 hours on weeks 3, 4, 8, 9, 13, 14, 18, and 19. Patients also receive pamidronate as in induction therapy for up to 1 year. Treatment continues in the absence of disease progression or unacceptable toxicity. Patients are followed monthly for 1 year.

PROJECTED ACCRUAL: A total of 75 patients (50 with localized disease; 25 with metastatic disease) will be accrued for this study within 3-4 years.

Genders Eligible for Study:  Both

Criteria

DISEASE CHARACTERISTICS:

• Histologically confirmed high-grade osteosarcoma
• Newly diagnosed
• Previously untreated
• Prior definitive surgical resection of primary tumor allowed
• No history of Paget's disease

PATIENT CHARACTERISTICS: Age

• Any age

Performance status

• ECOG 0-2

Life expectancy

• Not specified

Hematopoietic

• Platelet count at least 100,000/mm^3
• Absolute neutrophil at least 1,000/mm^3

Hepatic

• AST no greater than 3 times upper limit of normal (ULN)
• Bilirubin no greater than 1.5 times ULN

Renal

• Creatinine no greater than 1.5 times ULN

Cardiovascular

• Shortening fraction at least 28% by echocardiogram OR
• Ejection fraction at least 50% by radionuclide angiogram
• No history of pericarditis or myocarditis
• No history of symptomatic arrhythmia
• No history of symptomatic cardiac conduction abnormalities

Other

• Not pregnant or nursing
• Negative pregnancy test
• Fertile patients must use effective contraception
• No history of other cancer

PRIOR CONCURRENT THERAPY: Biologic therapy

• Not specified

Chemotherapy

• No prior chemotherapy

Endocrine therapy

• Not specified

Radiotherapy

• No prior radiotherapy

Surgery

• See Disease Characteristics

Other

• No prior treatment for cancer
• No concurrent enrollment on another therapeutic study

New York
      Memorial Sloan-Kettering Cancer Center, New York,  New York,  10021,  United States; Recruiting

Study chairs or principal investigators

Paul A. Meyers, MD,  Principal Investigator,  Memorial Sloan-Kettering Cancer Center   

Study ID Numbers:  CDR0000339591; MSKCC-03074; NCT00072306
Record last reviewed:  October 2003
Last Updated:  December 6, 2004
Record first received:  November 4, 2003
ClinicalTrials.gov Identifier:  NCT00072306
Health Authority: United States: Federal Government
ClinicalTrials.gov processed this record on 2005-04-08