The prognosis for patients with relapsed/metastatic
osteosarcoma is poor and the optimal treatment strategy remains to be refined. Whilst
gemcitabine plus
docetaxel combination treatment has already been demonstrated to have certain promising results in the treatment of
osteosarcoma, the use of
pemetrexed, a multi-targeted
antifolate, remains controversial. In the present study, a retrospective investigation was conducted to evaluate the toxicity and efficacy of the
pemetrexed plus
cisplatin combination in relapsed/metastatic
osteosarcoma. Comparison of this treatment with that of the
gemcitabine plus
docetaxel combination was also conducted. Clinical data from 39 patients suffering from refractory/metastatic
osteosarcoma between January 2005 and May 2011 were reviewed retrospectively. Of these patients, 21 were administered the
gemcitabine plus
docetaxel combination, and 18 were provided the
pemetrexed plus
cisplatin combination. Treatment was continued until the occurrence of
disease progression or unacceptable toxicity. In the
gemcitabine plus
docetaxel group, the overall response rate and disease control rate were found to be 9.5 and 28.5% respectively, compared with 5.5 and 33.3% respectively in the
pemetrexed plus
cisplatin group. The median progression-free survival (PFS) time was found to be 1.8 months for both the
gemcitabine plus
docetaxel and
pemetrexed plus
cisplatin groups. The median overall survival (OS) time was 6 months in the
gemcitabine plus
docetaxel group and 7 months in the
pemetrexed plus
cisplatin group. No statistically significant differences were recognized between the overall response rates, disease control rates, PFS times and OS times in the two groups. The two combinations appeared to be well tolerated. However, the incidence of grade 3/4
thrombocytopenia and leucopenia was higher in the
gemcitabine plus
docetaxel group than in the
pemetrexed plus
cisplatin group. The present study clearly demonstrated that both chemo-combinations were well-tolerated and exerted antitumor activity in patients with refractory/metastatic
osteosarcoma. However, with regard to grade 3/4 toxicity, the
pemetrexed plus
cisplatin chemotherapy appears to be better tolerated.