How do you approach adjuvant chemotherapy in an adult with localized osteosarcoma who demonstrates 50–90% tumor necrosis on surgical pathology following neoadjuvant doxorubicin and cisplatin?

There remains controversy regarding this. The largest trial to compare MAP (continuation of induction therapy into consolidation therapy) vs MAP-IE (addition of IE to conventional MAP) - EURAMOS-1 did not show any benefit to the addition of IE; however, certain centers still do so (i.e., MD Anderson...

Just to clarify, 90% necrosis is still considered "good" response. Assuming the question is about the <90% necrosis subset, and assuming the patient got AP x 4, we would switch to HD Ifex (14 g/m²/cycle) x 6 and HD MTX x 6, as long as renal and myelo tolerance is acceptable. Bottom line, all 4 activ...