Is there any outpatient protocol for cisplatin/doxorubicin neoadjuvant chemotherapy for osteosarcoma?

Outpatient administration of cisplatin/doxorubicin (albeit at a slightly reduced cisplatin dosage of 100 mg/m²) protocol is documented in the BC Cancer out in Vancouver, British Columbia. We offer this at Roswell, with the addition of mannitol, but it is a long 8-hour day, and close follow-up is recommended. However, it is doable and tolerated.

The standard doses are 75 mg/m² of dox and 120 mg/m² of CDDP - hard to deliver as an outpatient. Cisplatin is not a schedule-dependent drug, so if there were compelling reasons not allowing hospitalization, one could split the cisplatin into 2 or 3 weekly doses. The old NSCLC regimens used to give weekly cisplatin. Full disclosure - I have never done this for osteosarcoma!

We also administer cisplatin and doxorubicin as outpatient therapy to our adolescent and young adult (AYA) patients with osteosarcoma. We give the 60 mg/m² dose daily x2 but without the use of mannitol, following a literature search and consensus building to harmonize pediatric and medical oncology administration practices. It is a long day, and some patients require overnight hydration via a "backpack" and pump, but it is generally preferred over inpatient administration by this population. This was published last year: Daukshus et al., PMID 39008434.