How can we improve current treatments for osteosarcomas?
Prof Stefan Bielack - Klinikum Stuttgart, Stuttgart, Germany
Could you give an overview on your work on paediatric oncology and bone cancer?
I’m involved in treating bone cancer, particularly osteosarcoma which is one of the most common solid tumours of adolescents and young adults. There I’m the Chair of the German Austrian Swiss Osteosarcoma Study Group and also principle investigator of the European and American osteosarcoma study.
What is the current state-of-play with treatment for osteosarcoma?
The current standard is treatment with both systemic treatment and surgery. About ten weeks of pre-op chemo, surgery and another twenty weeks of post-op chemo. There are three drugs which are considered standard and that’s high dose methotrexate, doxorubicin and cisplatin.
Are there any future treatments lined up?
Maybe we can go back and take a look at what’s happened over the past decades. So actually there has been a lot of progress as far as surgery is concerned. It used to be that affected patients lost their limbs, usually the osteosarcomas around the knee, and they were amputated. There has been a major shift towards limb salvage and so nowadays many people can keep their limbs. Chemotherapy is basically the same as it was 35 years ago, there has been very little change. So groups from around the world got together and in 2001 we started planning and we’ve run a study in Europe and North America which accrued over 2,000 patients trying to improve things. We were successful in running the study, unfortunately none of our experimental arms proved to be better than the standard.
Are you working on any other trials?
We are looking for agents which would warrant trials and we’ve just had a meeting, a two-day meeting here, a very exciting meeting prior to the ECCO conference where the basic scientists, translational researchers and clinicians got together trying to see which avenues we should take for further trials. But there is no osteosarcoma trial just ready to be opened at the moment.
Can you give examples of these potential avenues?
Not very surprising, everyone is talking about immune checkpoint blockade and that’s one way which might be going. I’m not sure, really, where we will end up. At the moment the drugs that work are chemo, conventional chemo. Good cure rates but still 30%, 40% in some risk situations of recurrences. We’ll need to build up on that; we cannot do without chemo but we will need to see what we can add to that.
What are the next steps for managing paediatric cancers?
One thing which is important when it comes to this conference, multidisciplinarity, is that osteosarcoma is one of the tumours where paediatric oncologists and adult oncologists co-operate very well. So we have medical oncologists in the trial groups and paediatric oncologists in the trial groups and that’s the way forward for teenage and adolescent, young adult cancer; I believe that we need to work together across the specialities. Our paediatric oncology society, SIOPE Europe, has just written a European cancer plan for children and adolescents and one of the five topics is that we need to get better co-operation with our medical oncology colleagues.