Uniting providers across institutions to support osteosarcoma care: Insights from 64 cases reviewed through the MIB agents TURBO board.

Abstract

e13540 Background: TURBO (Tumor Review Board for Osteosarcoma), launched in 2022 by MIB Agents Osteosarcoma Alliance, is a global bi-monthly virtual tumor board designed to support oncology providers managing complex osteosarcoma cases. From February 2022 – November 2025, TURBO held 21 one-hour sessions reviewing 64 cases presented by 50 clinicians from 43 institutions across 8 countries. Summary notes were distributed after each meeting to facilitate the dissemination of expert guidance. Methods: Presenting oncologists submitted standardized case data reflecting patient status at review. Physicians received online surveys 1 week and 6 months post-presentation, assessing TURBO’s usefulness and impact. Results: Demographics reflected the US osteosarcoma population (54.7% male), but skewed younger (76.6% aged 10–24 years). Cases spanned the US; 10 (15.6%) were non-US. More than half (56.3%) were treated at sarcoma centers. Most tumors (64.1%) were lower extremity; metastatic disease was common (82.8%), primarily to the lung (71.9%) and bone (21.9%), with some soft-tissue, CNS, and nodal sites. Disease status at presentation reflected high complexity: 25.0% initial diagnosis, 45.3% progression, and 29.7% recurrence. Most had prior surgery (87.5%) and ≥2 treatment lines (65.6%), with two-thirds (67.2%) receiving ≥4 agents. MAP was the first-line regimen for 84.4%. Common subsequent therapies included ifosfamide/etoposide (39.1%), cabozantinib (23.4%), regorafenib (18.8%), and gemcitabine/docetaxel (17.2%). At presentation, 26.6% had enrolled in ≥1 clinical trial. One week post, 100% of TURBO presenters rated TURBO as very helpful, and 37.5% reported immediate treatment-plan changes. At 6 months, 82.4% reported that the patient received treatment following TURBO, and 70.6% found the discussion helpful in determining the plan. Six-month outcomes were 17.6% NED, 23.5% stable, 35.3% progression, and 23.5% deceased. Physicians valued multidisciplinary input for complex rare cases, gained confidence exploring therapy options, and learned from peers. Recommendations often provided clear guidance, while differing opinions highlighted ongoing uncertainties. At 1 week, 100% rated TURBO as very helpful; 37.5% reported a treatment-plan change, 33.3% maybe, and 29.2% no change. Conclusions: TURBO provides a collaborative forum delivering multidisciplinary expertise to clinicians treating rare high-risk osteosarcoma. Cases reflected a heavily pre-treated, predominantly metastatic population, underscoring the need for shared decision-making. TURBO discussions improved clinician confidence, informed real-time treatment planning, and supported identification of clinical trial options. This scalable international forum strengthens cross-institutional collaboration and may enhance consistency and quality of care in osteosarcoma.