In the Japanese JCOG0905 study presented by Dr. Hiroaki Hiraga, adding Ifosfamide (IF) to adjuvant chemotherapy in high grade osteosarcoma patients with poor response to preoperative chemo (> 10% viable tumor cells at surgery) didn’t improve the DFS or OS. The study randomized 103 patients, poor responders to preoperative Methotrexate, Adriamycin, and Cisplatin (MAP) to either continuation of MAP alone or MAP + IF (15 g/m2 × 6 courses), with a total dose of 90 g/m2. However, the 3-year DFS was 64.3% in MAP and 64.3% in MAP + IF (hazard ratio (HR) 1.05, 95% CI 0.57-1.91).