Osteosarcoma Research is Helping Personalize Treatment Options

In this video, Santiago Lozano-Calderon, MD, PhD, surgeon in the Orthopaedic Oncology Service at Massachusetts General Hospital and the Mass General Cancer Center, discusses the latest innovations in treating bone cancer using patient profiling to develop more targeted treatment plans.

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Transcript

We're doing very interesting research in micro RNA molecules in patients, mainly with osteosarcoma, which will help us to develop models for what we call liquid biopsies, in which we are able to identify the primary patients that will respond or will not respond to chemotherapy, patients that are at risk of pathologic fracture or not, and patients that may not respond specifically to a particular type of chemotherapy in establishing the risk of those patients in terms of local recurrence or metastatic disease. The most beneficial part of the micro RNA in the calculators is that they are going to help us to give a patient a specific treatment. Unfortunately, in sarcoma care, we don't know as much as we do of other types of cancers, and we know that each patient is different and it doesn't have to respond to the different interventions in the same manner that other patients do. We have clinical cases, and most of my colleagues have the same experiences, in which we have a patient that we expect that is going to have a great response based on the size of the tumor, the gender of the patient, this type of surgery, the type of response to the chemotherapy or radiation therapy and then, later on, we see that that patient doesn't do as well as we were expecting. And, vice versa, we have patients in which we expect a very poor outcome, but, for some reason, they end up doing much better in the long term.

So, this calculator in this micro RNA research will facilitate to tailor the treatment for those patients and give more specific information to the patient based on their demographics, their genetics, the size of the tumor, the histology of your tumor, the biomarkers of your tumor, to a specific risk, not the general population risk, and that will help patients to make more informed decisions in terms of the treatments that they want to undertake based on the goals that they have for their lives. So having that information and having an artificial intelligence model based on histologic and genetic information that will help us to tell the patient, "Look, based on your genetics of your tumor this by the toxicity, it seems that you will respond very well of two of the medications that we usually use for the conventional treatment".

So, one of the alternatives that we have in specific care is, instead of giving you a conventional treatment with three or four drugs or five drugs, we will give you a specific treatment just with two of the drugs that we know that work for your tumor, and the possibilities of that working are X, Y, and Z in that person at age 65 depending on where during life they may decide to pursue a treatment or not pursue treatment or go with the conventional one once they get the number. So I think it is important to have these instruments so patients can have information and decide what is what they want basically following their goals for their life, their religious and ethical beliefs and other things are part of the patient as a whole.

The advancements that we are going to see in the field of orthopedic oncology with this technology is that patients sign up to a chemotherapy knowing this is my best shot, this is how it works in the general population, but I don't know if this is going to be good for me. Having all these calculators with containing histologic markers of the tumor and micro RNA molecules will allow us to identify those patients in the future that are going to respond very well to chemotherapy or not, in advance. So we can have an honest conversation with the patient and tell them, "Look, conventional chemotherapy in your case has a very good likelihood to work, go for it, and it is worth it to go through the side effects of chemotherapy because the likelihood of cure is pretty high in your specific case". When you have the patient that is not going to respond well to chemotherapy, we know in advance and then we can prevent that patient of undergoing unnecessary treatment side effects and then explore other treatments and options that might work better for that patient, different than the conventional or the norm of the osteosarcoma population.

Learn more about the Orthopaedic Oncology Service at Mass General

Refer a patient to the Department of Orthopaedic Surgery