Management of pediatric bone sarcomas

Although the activity of single-agent checkpoint inhibitors remains disappointing in pediatric bone tumors, rational tyrosine kinase inhibitor-chemotherapy combinations, improved biologic risk stratification (ctDNA; MYC in OS; STAG2 in ES), recycling chemotherapeutic agents, and standardized local-control frameworks are being developed to reshape care. Near-term priorities include biomarker-anchored upfront trials and supportive-care measures that preserve cure while reducing late effects. Clinical trials provide access to potentially paradigm-shifting therapeutic strategies.