91 patients with metastatic osteosarcoma were randomized to receive a 3-drug treatment of chemotherapy (cisplatin, doxorubicin, and high-dose methotrexate) with or without ifosfamide. Within each group patients were further randomized to either receive liposomal muramyl tripeptide phosphatidylethanolamine (MTP-PE) or not to determine whether the addition of liposomal MTP-PE to chemotherapy was effective in improving survival. After a median of 89 months, results indicated that there were no significant differences between groups in terms of survival, with MTP-PE trending towards superiority. Also, outcomes were worse in male patients, those with high lactate dehydrogenase, high alkaline phosphatase, metastatic bone involvement, and of non-Caucasian descent.