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**Lenvatinib + ifosfamide + etoposide** is an investigational combination regimen for the treatment of relapsed or refractory high-grade osteosarcoma, primarily in children and young adults. **Lenvatinib** is an oral multikinase inhibitor targeting vascular endothelial growth factor receptors (VEGFR1-3), fibroblast growth factor receptors (FGFR1-4), platelet-derived growth factor receptor alpha (PDGFRα), RET, and KIT, suppressing tumor angiogenesis and proliferation. **Ifosfamide** is an alkylating agent causing DNA cross-linking and inhibition of DNA synthesis, while **etoposide** inhibits topoisomerase II, resulting in DNA damage and apoptosis. This combination is studied to potentially enhance antitumor activity compared to standard chemotherapy alone[1][3][4].
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