Resource-appropriate selection of osteosarcoma treatment protocols in low- and middle-income countries

Osteosarcoma is a rare malignancy; however, it is still the most common primary bone tumor in adolescents and young adults. Chemotherapy improves survival indubitably in osteosarcoma; nevertheless, the concern is the stagnant progress since the last several decades. There are a handful of active agents and unresolved issues, especially in choosing the ideal chemotherapy regimen. The oncology community is in equipoise regarding the position of high-dose methotrexate (HDMTX), mandatory or adjunct. The choice of therapy becomes widely relevant, including in low- and middle-income countries (LMIC), where HDMTX administration brings additional complexities. Research into novel non-HDMTX-based protocols adapted to the available resources is pivotal in improving disease outcomes, especially in LMIC. The current review focuses on real-world challenges in decision-making and provides a comprehensive overview of the evolution of treatment protocols in LMIC.

Automated summary

Osteosarcoma is the most common primary bone tumor in adolescents and young adults, with chemotherapy improving survival rates. However, there are unresolved issues in choosing the ideal chemotherapy regimen, especially regarding the role of high-dose methotrexate in the oncology community. Further research into non-methotrexate-based protocols adapted to available resources is crucial for improving disease outcomes, particularly in low- and middle-income countries.