Hatice Mine ÇAKMAK, Yaşar BİLDİRİCİ, Funda ÇORAPCIOĞLU, Harzem ÖZGER, Ayten KAYI CANGIR, Meral BAHAR

Metastatik Nüks Osteosarkomda Sorafenib Kullanımı: Olgu Sunumu

Nüks metastatik osteosarkomda birincil tedavi metastatik ve nüks tüm lezyonların cerrahi rezeksiyonudur. Nüks osteosarkomda ifosfamid, gemsitabin-docetaxel, VOİT (vinkristin-irinotekan-temozolamid, bevacizumab) verilebilmektedir. Seçili olgularda radyoterapi de uygulanmaktadır. Tirozin kinaz inhibitörlerinden, pazopanib ve sorafenibin refrakter osteosarkomda etkinliği gösterilmiştir. Bu vaka sunumunda, primer bölge nüksünde de radyoterapi sonrası ekstremite koruyucu cerrahi yapılan, sonrasında sırasıyla ifosfamid-doksorubisin, yüksek doz metotreksate, ifosfamid alan, akciğer metastatektomisi sonrası 6 kür VOİT alan, pazopanibi tolere edemeyen ve sorafenib ile idame tedavisi yapılan olgu sunulmaktadır. Olgu, son kemoterapiden sonra sekiz aydır remisyondadır. Sorafenib, nüks riski yüksek olan, remisyon sağlanan olgularda, mikroskopik rezidüel hastalık için güvenle bir yıl verilebilir.

Anahtar Kelimeler:

relaps, , metastaz, , çocuk,

Sorafenib as a maintenance therapy in an adolescent with relapsed-metastatic osteosarcoma

The mainstay treatment for recurrent metastatic osteosarcoma is surgical resection of all metastatic and recurrent lesions. Ifosfamide, gemcitabine-docetaxel, VOIT (vincristine-irinotecan-temozolamide, bevacizumab) can be given in relapsed osteosarcoma. Radiotherapy is also applied in selected cases. The efficacy of tyrosine kinase inhibitors, pazopanib, and sorafenib, has been demonstrated in refractory osteosarcoma. In this case report, a case who underwent ten days radiotherapy and limb-sparing surgery in primary site recurrence, followed by ifosfamide-doxorubicin, high-dose methotrexate, and ifosfamide, received 6 cycles of VOIT after lung metastasectomy, could not tolerate pazopanib, and was treated with sorafenib as a maintenance treatment is presented. The case has been in remission for eight months after the last chemotherapy. Sorafenib can be safely given for one year for microscopic residual disease in remission-remitting patients with a high risk of relapse

Keywords:

relapses, metastases, osteosarcoma, children, sorafenib, pazoponib relapses, metastases, osteosarcoma, children, sorafenib, pazoponib,

PDF

___

1. Simpson E, Brown HL. Understanding osteosarcomas. Journal of the American Academy of Physician Assistants 2018;31:15-9.
2. Megan E, Anderson MD. Update on survival in osteosarcoma. Orthop Clin N Am 2016;16:283-92.
3 Janeway KA, Barkauskas DA, Krailo MD, Meyers PA, Schwartz CL, Ebb DH, Seibel NL, Grier HE, Gorlick R, Marina N. Outcome for adolescent and young adult patients with osteosarcoma: a report from the Children's Oncology Group. Cancer. 2012 Sep 15;118(18):4597-605.
4. Goorin AM, Schwartzentruber DJ, Devidas M,et al; Pediatric Oncology Group. Presurgical chemotherapy compared with immediate surgery and adjuvant chemotherapy for nonmetastatic osteosarcoma: Pediatric Oncology Group Study POG-8651. J Clin Oncol. 2003;15:1574-80.
5.Marina NM, Smeland S, Bielack SS, et al. Comparison of MAPIE versus MAP in patients with a poor response to preoperative chemotherapy for newly diagnosed high-grade osteosarcoma (EURAMOS-1): an open-label, international, randomised controlled trial. Lancet Oncol 2016; 17:1396.
6.Goorin AM, Shuster JJ, Baker A, Horowitz ME, Meyer WH, Link MP. Changing pattern of pulmonary metastases with adjuvant chemotherapy in patients with osteosarcoma: results from the multiinstitutional osteosarcoma study. J Clin Oncol. 1991;9:600-5.
7.Patel SR, Vadhan-Raj S, Papadopolous N, Plager C, Burgess MA, Hays C, Benjamin RS. High-dose ifosfamide in bone and soft tissue sarcomas: results of phase II and pilot studies--dose-response and schedule dependence. J Clin Oncol. 1997;15:2378-84.
8. Kung FH, Pratt CB, Vega RA, et al. Ifosfamide/etoposide combination in the treatment of recurrent malignant solid tumors of childhood. A Pediatric Oncology Group Phase II study. Cancer. 1993;71:1898-903.
9. Navid F, Willert JR, McCarville MB, et al. Combination of gemcitabine and docetaxel in the treatment of children and young adults with refractory bone sarcoma. Cancer. 2008;113:419-25.
10. Wagner L, Turpin B, Nagarajan R, Weiss B, Cripe T, Geller J. Pilot study of vincristine, oral irinotecan, and temozolomide (VOIT regimen) combined with bevacizumab in pediatric patients with recurrent solid tumors or brain tumors. Pediatr Blood Cancer. 2013;60:1447-51.
11. Bishop MW, Janeway KA. Emerging concepts for PI3K/mTOR inhibition as a potential treatment for osteosarcoma. F1000Res. 2016 Jul 6;5:F1000 Faculty Rev-1590.
12. Bielack SS, Kempf-Bielack B, Branscheid D, Carrle D, Friedel G, Helmke K, Kevric M, Jundt G, Kühne T, Maas R, Schwarz R, Zoubek A, Jürgens H. Second and subsequent recurrences of osteosarcoma: presentation, treatment, and outcomes of 249 consecutive cooperative osteosarcoma study group patients. J Clin Oncol. 2009;27:557-65.
13. Daw NC, Chou AJ, Jaffe N, et al. Recurrent osteosarcoma with a single pulmonary metastasis: a multi-institutional review. Br J Cancer. 2015;112:278-82.
14. Tabone MD, Kalifa C, Rodary C, Raquin M, Valteau-Couanet D, Lemerle J. Osteosarcoma recurrences in pediatric patients previously treated with intensive chemotherapy. J Clin Oncol. 1994;12:2614-20.
15. Leary SE, Wozniak AW, Billups CA, et al. Survival of pediatric patients after relapsed osteosarcoma: the St. Jude Children's Research Hospital experience. Cancer. 2013;119:2645-53.
16. Wagner L, Turpin B, Nagarajan R, Weiss B, Cripe T, Geller J. Pilot study of vincristine, oral irinotecan, and temozolomide (VOIT regimen) combined with bevacizumab in pediatric patients with recurrent solid tumors or brain tumors. Pediatr Blood Cancer. 2013;60:1447-51.
17. van der Graaf W, Blay J, Chawla S, et al. Pazopanib for metastatic soft-tissue sarcoma (PALETTE): a randomised, double-blind, placebo-controlled phase 3 trial. Lancet. 2012;379: 1879–1886.
18. Umeda K, Kato I, Saida S, et al. Pazopanib for second recurrence of osteosarcoma in pediatric patients. Pediatr Int. 2017;59:937–938.
19) Longhi A, Paioli A, Palmerini E,et al. Pazopanib in relapsed osteosarcoma patients: report on 15 cases. Acta Oncol. 2019;58(1):124-128.
20) Liu Y, Huang N, Liao S, Rothzerg E, Yao F, Li Y, Wood D, Xu J. Current research progress in targeted anti-angiogenesis therapy for osteosarcoma. Cell Prolif. 2021:e13102.
20. Liu Y, Huang N, Liao S, Rothzerg E, Yao F, Li Y, Wood D, Xu J. Current research progress in targeted anti-angiogenesis therapy for osteosarcoma. Cell Prolif. 2021:e13102.