COSS-86

Regimen

Experimental
Intensified neoadjuvant with high-dose MTX + doxorubicin + cisplatin + ifosfamide (risk-adapted)
Control
Historical COSS-82 standard without ifosfamide (non-randomized)

Population

High-risk non-metastatic osteosarcoma of extremity (large tumor, axial, or young age), neoadjuvant then histology-adapted adjuvant

Key finding

Adding ifosfamide to the MAP backbone in high-risk patients did NOT meaningfully improve long-term EFS/OS versus historical COSS-82. Added toxicity without clear survival gain — earliest European signal that intensification has hit a wall.

Source: PMID 9789613

Timeline

    Guideline citations

    • NCCN BONE (p.110)