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Osteosarcoma is an aggressive form of bone cancer which progresses quickly. Treatment for osteosarcoma has remained the same for around 40 years. New avenues of treatment need to be researched and trialled to improve outcomes for patients.

One path for treatment includes combining medicines that target weaknesses in cancer cells. This is compared to standard chemotherapy which may not be as effective on its’ own. This is because other treatments can specifically target cancerous (malignant) cells more so than standard chemotherapy. One group of medicines target parts of cancer cells which manage how fast cancer cells grow and divide. This group of medicines are called tyrosine kinase inhibitors (TKIs) and they work by treating parts of cells called tyrosine kinase receptors (TKRs).

This paper looks at how well these TKI treatments work in treating osteosarcoma and whether these treatments could be safely used. Treatment included TKI treatment on its own and use at the same time as standard chemotherapy.

How do the researchers do this?

The authors of this paper looked at the use of TKIs for osteosarcoma treatment by reviewing what existing research has been published. This method is called a systematic review.

What is a Systematic Review?

A systematic review involves doing a search on online medical libraries for research studies involving your chosen topic. In this study, the chosen topics include osteosarcoma and TKI treatment. The researchers then narrow down the most relevant studies to their research question and compare the research methods used, as well as the results of these chosen studies. In this systematic review, any papers published before 2020 were excluded, as it is important to use up-to-date information. In total, 93 studies of medical trials involving TKI treatment are included in this review.

A flow chart with the following stages: 
1. Decide on a research topic and search words to use (e.g. osteosarcoma) to get the best results
2. Search published research papers on your topic using a library of published studies
3. Narrow down the results using your search rules (e.g. none prior to 2020). Can we use the evidence (is it a trusted source)?
4. You are left with your studies to read in full, extract information and compare results

What did they find?

The papers reviewed indicated that TKI treatment in osteosarcoma could be an effective avenue in future treatment pathways. Seven TKI medicines were identified as possible treatment by targeting TKRs in osteosarcoma. Researchers also noted the following:

•	Individually targeted matching of TKI treatment to each patient could improve outcomes for osteosarcoma patients. 
•	This could be done by using biomarkers in patients which can be matched with TKI medicine for a tailored approach. However, TKI treatment alone is not enough to treat osteosarcoma.
•	Combining TKI treatment with chemotherapy was identified as a more effective treatment plan.
•	Large scale clinical trials are needed to understand how well TKIs and chemotherapy work as a possible treatment plan for cases where osteosarcoma has spread further in the body (metastatic).
Biomarker definition: a biological marker of a body process which can help diagnose illness (for example measuring iron levels in blood samples to test for anaemia)

Treatment side effects were a common reason for changing medicines in treatment. Side effects can affect the quality of life for patients. The authors recommend that in larger clinical trials for TKI/chemotherapy combination use in osteosarcoma, quality of life is looked at with each patient to understand this better.

What does this mean?

The authors have identified a treatment pathway for osteosarcoma with targeted TKI treatment alongside chemotherapy. In future, large scale clinical trials are recommended to develop this treatment. In these clinical trials it would be important to look at quality of life of patients to see if this combination of therapies improves quality of life as well as helping patients continue TKI and chemotherapy treatment for the cancer.

Reference:
Assi A, Farhat M, Hachem MCR, Zalaquett Z, Aoun M, Daher M, Sebaaly A, Kourie HR. Tyrosine kinase inhibitors in osteosarcoma: Adapting treatment strategiesa. J Bone Oncol. 2023 Nov 3;43:100511. doi: 10.1016/j.jbo.2023.100511. PMID: 38058514; PMCID: PMC10696463.