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Miscellaneous: Bone sarcoma: osteosarcoma chemotherapy

Free question published 25 October 2026

MiscellaneousBone sarcoma: osteosarcoma chemotherapy

A 15-year-old boy is diagnosed with a localised high-grade osteosarcoma of the distal femur. He is referred to a bone sarcoma MDT for neoadjuvant chemotherapy, limb-salvage surgery and adjuvant chemotherapy. Which combination chemotherapy backbone represents the standard of care for newly diagnosed high-grade osteosarcoma?

  1. ACisplatin, doxorubicin and high-dose methotrexate (MAP)
  2. BCarboplatin and paclitaxel
  3. CStreptozocin and 5-fluorouracil
  4. DSingle-agent high-dose methotrexate
  5. EVincristine, doxorubicin and cyclophosphamide alternating with ifosfamide and etoposide

Why A is correct

The standard chemotherapy backbone for newly diagnosed high-grade osteosarcoma is MAP: high-dose methotrexate, doxorubicin (Adriamycin) and cisplatin. The EURAMOS-1 trial established MAP as the international standard neoadjuvant and adjuvant regimen for resectable high-grade osteosarcoma, with histological response to neoadjuvant MAP guiding postoperative management.

And why the others are not

  • BCarboplatin and paclitaxel is not a standard osteosarcoma regimen.
  • CStreptozocin and 5-fluorouracil is used for pancreatic neuroendocrine tumours, not osteosarcoma.
  • DSingle-agent methotrexate is insufficient; osteosarcoma requires multi-agent MAP.
  • EVDC/IE is the Ewing sarcoma regimen, not the osteosarcoma standard.

Source ESMO-EURACAN-GENTURIS-ERN PaedCan Clinical Practice Guidelines - Bone sarcomas — Strauss SJ, Frezza AM, Abecassis N, et al. Bone sarcomas: ESMO-EURACAN-GENTURIS-ERN PaedCan Clinical Practice Guideline for diagnosis, treatment and follow-up. Ann Oncol. 2021;32(12):1520-1536.

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