Introduction: Current treatment of conventional and non-conventional high-grade osteosarcoma (HGOS) is based on the surgical removal of primary tumor and, when possible, of metastases and local reccurrence, together with systemic pre- and post-operative chemotherapy with drugs that have been used since decades. Areas covered: This review is intended to summarize the new agents and therapeutic strategies that are under clinical evaluation in HGOS, with the aim to increase the cure probability of this highly malignant bone tumor, which has not significantly improved during the last 30-40 years. The list of drugs, compounds and treatment modalities presented and discussed here has been generated by considering only those that are included in presently ongoing and recruiting clinical trials, or which have been completed in the last 2 years with reported results, on the basis of the information obtained from different and continuously updated databases. Expert opinion: Despite HGOS is a rare tumor, several clinical trials are presently evaluating different treatment strategies, which may hopefully positively impact on the outcome of patients who experience unfavorable prognosis when treated with conventional therapies.
Trial registration: ClinicalTrials.gov NCT01459484 NCT01669369 NCT00134030 NCT00180908 NCT00470223 NCT01532687 NCT02357810 NCT03163381 NCT02432274 NCT02048371 NCT02389244 NCT02243605 NCT02867592 NCT03210714 NCT03526250 NCT03213678 NCT03718091 NCT03233204 NCT03698994 NCT03220035 NCT03220035 NCT02689336 NCT03678883 NCT01962103 NCT02945800 NCT01669369 NCT03598595 NCT02644460 NCT02517918 NCT03002805 NCT02013336 NCT02536183 NCT02557854 NCT02390843 NCT03643133 NCT03006848 NCT03676985 NCT03277924 NCT03190174 NCT02304458 NCT02406781 NCT02502786 NCT03860207 NCT03320330 NCT03610490 NCT02100891 NCT02508038 NCT03356782 NCT01953900 NCT03618381 NCT03462316 NCT02487979.
Keywords: Osteosarcoma; biomarkers; chemotherapy; drug resistance; pharmacogenomics; tailored therapy; targeted drugs.