Iron-Related Metabolic Targets in the Treatment of Osteosarcoma: Research Progress and Prospects

Iron metabolism has emerged as a critical regulator of cancer biology, with mounting evidence linking iron dysregulation to tumor initiation, progression, and resistance mechanisms. Osteosarcoma (OS) is the most common primary bone malignancy and a leading cause of cancer-related death in children and young adults; recent studies have identified profound alterations in iron homeostasis at both cellular and microenvironmental levels in OS. These include increased iron uptake, disrupted storage and export, and a reliance on iron-dependent metabolic pathways that promote proliferation, metastasis, and immune evasion. Despite advances in surgical and chemotherapeutic approaches, survival outcomes in OS have stagnated, underscoring the need for novel therapeutic strategies. Targeting iron metabolism represents a promising avenue, with strategies such as iron chelation, transferring receptor inhibition, ferroptosis induction, and modulation of ferritinophagy, showing preclinical efficacy. In this review, we provide an updated and integrated overview of the multifaceted role of iron in OS pathogenesis, dissect emerging therapeutic approaches aimed at disrupting iron regulatory networks, and highlight innovative delivery platforms including nanomedicine. By integrating current insights on iron metabolism with the molecular complexity of OS, we present a comprehensive perspective, while acknowledging that the limited clinical translatability of current findings still hinders progress toward clinical application. A deeper understanding of iron-driven mechanisms may guide future studies toward the development of safe and effective iron-targeted therapies for OS.