Background. Osteosarcoma is a highly malignant bone tumour. After the second relapse, the 12-month postrelapse disease-free\r\nsurvival (PRDFS) rate decreases below 20%. Oral Etoposide is often used in clinical practice after surgery as an ââ?¬Å?adjuvantââ?¬Â outside\r\nany protocol and with only limited evidence of improved survival. Viscum album fermentatum Pini (Viscum) is an extract of\r\nmistletoe plants grown on pine trees for subcutaneous (sc) injection with immunomodulatory activity. Methods. Encouraged by\r\npreliminary findings, we conducted a study where osteosarcoma patients free from disease after second metastatic relapse were\r\nrandomly assigned to Viscum sc or Oral Etoposide. Our goal was to compare 12-month PRDFS rates with an equivalent historical\r\ncontrol group. Results. Twenty patients have been enrolled, with a median age of 34 years (range 11ââ?¬â??65) and a median follow-up\r\ntime of 38.5 months (3ââ?¬â??73). The median PRDSF is currently 4 months (1ââ?¬â??47) in the Etoposide and 39 months (2ââ?¬â??73) in the Viscum\r\ngroup. Patients getting Viscum reported a higher quality of life due to lower toxicity. Conclusion. Viscum shows promise as adjuvant\r\ntreatment in prolonging PRDFS after second relapse in osteosarcoma patients. A larger study is required to conclusively determine\r\nefficacy and immunomodulatory mechanisms of Viscum therapy in osteosarcoma patients.
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