Chemotherapy for Patients With Osteosarcoma

• Time to Treatment Failure [ Time Frame: Baseline to 21 months ] [ Designated as safety issue: Yes ]
  When the protocol was written, time to treatment failure (TTTF) was included as a secondary endpoint. However, it was subsequently realized that due to the design of the study, participants are treated until disease progression or discontinuation from study treatment, not for a fixed number of cycles. Therefore, it was concluded that analysis of TTTF was inappropriate with the current study design and the analysis was not conducted, since it would be essentially the same as Progression-Free Survival.
• Correlation of Disease Outcome With Pharmacogenomic Analysis [ Time Frame: Baseline to 21 months ] [ Designated as safety issue: No ]
  It was planned to examine methylthioadenosine phosphorylase (MTAP) gene deletion, folate receptor alpha (FRα) and folylpoly-gamma-glutamate synthetase (FPGS) expression, and to correlate the results with the clinical data to determine the association between these factors and clinical outcome to treatment. However, due to the small number of participants with partial response (n=1), the planned statistical analyses that would correlate responders/non responders with pharmacogenomics data are no longer valid and the analyses were not conducted.
• Number of Participants With Adverse Events (Pharmacology Toxicity) [ Time Frame: Baseline to 21 months ] [ Designated as safety issue: Yes ]
  Pharmacology toxicity was defined as serious and non-serious adverse events. Summaries of these adverse events are located in the Reported Adverse Event Section.
• Duration of Response [ Time Frame: Baseline to 31 months ] [ Designated as safety issue: No ]
  The duration of a complete response (CR) or partial response (PR) was defined as the time from the first objective status assessment of CR or PR to the first date of progression or death as a result of any cause: CR was achieved if all tumor lesions disappeared; PR was achieved if there was >=30% decrease in sum of the longest diameter (LD) of target lesions (reference: baseline sum LDs) or complete disappearance of target lesions with persistence (but not worsening) of >=1 nontarget lesions and no appearance of new lesions.
• Progression-Free Survival (PFS) [ Time Frame: Baseline to 10.4 months ] [ Designated as safety issue: No ]
  PFS was from date of study enrollment to first date of objectively determined progressive disease (PD) or death from any cause. For participants who did not die as of data cut-off date and who did not have objective PD, PFS was censored at date of last objective progression-free disease assessment. For participants who received subsequent systemic anticancer therapy (after discontinuation from study drug) before objectively determined disease progression or death, PFS was censored at date of last objective progression-free disease assessment, before post-discontinuation chemotherapy.
• Overall Survival (OS) Time [ Time Frame: Baseline to 27.6 months ] [ Designated as safety issue: Yes ]
  OS was the duration from enrollment to death. For participants who lived, OS was censored at the last contact.

• Duration of response for responding patients [ Time Frame: 2 years ]
• Progression-free survival [ Time Frame: 2 years ]
• Time to treatment failure [ Time Frame: 2 years ]
• Overall survival time [ Time Frame: 2 years ]
• To examine the toxicity and safety profile of study treatment. [ Time Frame: 30 days after discontinuation ]
• Correlation of disease outcome with pharmacogenomic analysis; MTAP gene deletion, FRα and FPGS expression will be correlated with the clinical data to determine the association between these factors and clinical outcome to treatment [ Time Frame: 2 years ]

The primary purpose of your participation in this study is to help answer the following research questions, and not to provide you treatment for your condition.

• To assess how well treatment with pemetrexed works for patients with your type of cancer
• To assess for any side effects that might be associated with pemetrexed.
• To look at the characteristics and levels of certain of your genes and proteins to learn more about osteosarcoma and how pemetrexed works in your body.

Inclusion Criteria:

• Histological diagnosis of high grade locally advanced or metastatic osteosarcoma
• Must have one prior chemotherapy regimen for advanced disease
• At least 1 unidimensional measurable lesion by computed tomography (CT) scan
• Have a good performance status
• Adequate organ function

Exclusion Criteria:

• Have a serious concomitant systemic disorder (for example active Human Immunodeficiency Virus infection)
• Have brain metastases not adequately treated
• Significant weight loss (that is more than 20%) over the previous 6 weeks before study entry
• Inability or unwillingness to take folic acid or vitamin B12 supplementation and corticosteroids
• Pregnant or breast-feeding