Research in bone cancer

We are always learning more about cancer. Researchers and healthcare professionals use what they learn from research studies to develop better ways to find and treat cancer. They are also looking for ways to improve the quality of life of people with cancer.

The following is a selection of research showing promise for treating bone cancer. We've included information from the following sources. Each item has an identity number that links to a brief overview (abstract).

  • PubMed, US National Library of Medicine (PMID)

  • American Society of Clinical Oncology (ASCO)
  • Canadian Cancer Trials and ClinicalTrials.gov (NCT)

Surgery

Researchers are looking for the best ways to treat bone cancer using surgery and improve how surgery is done.

Computer-assisted surgery can be helpful in planning and making decisions about treatment. It can also improve the accuracy of surgery by guiding surgeons and giving them feedback. One study showed computer-assisted surgery gave outcomes similar to using fluoroscopy (which uses radiation) to plan surgery to treat grade 1 chondrosarcoma in long bones (PLoS One, PMID 29771927).

Chemotherapy

The following is noteworthy research in chemotherapy for bone cancer.

High-dose methotrexate is one of the chemotherapy drugs used to treat osteosarcoma. This drug is often given to children and young adults because it passes through their bodies quickly. The bodies of older adults can't remove this drug as quickly, so it can cause kidney problems. One study reported a new chemotherapy regimen using high-dose methotrexate with etoposide (Vepesid, VP-16) and ifosfamide (Ifex) was as effective as standard chemotherapy using high-dose methotrexate, doxorubicin (Adriamycin) and cisplatin for preoperative chemotherapy in adults 25 years and younger (European Journal of Cancer, PMID 29190507). Another study showed that protocols used for younger people can increase the survival in people older than 40 years of age with high-grade osteosarcoma, but side effects are much more severe in older people (Tumori, PMID 29218692).

Gemcitabine (Gemzar) combined with docetaxel (Taxotere) showed promise in one clinical trial for treating newly diagnosed high-risk Ewing sarcoma in children and adults (British Journal of Cancer, PMID 28787430).

Irinotecan (Camptosar) and temozolomide (Temodal) is an effective salvage chemotherapy regimen for relapsed Ewing sarcoma (ASCO, Abstract e22500).

Metformin and chloroquine are being studied in an early clinical trial to treat IDH1- or IDH2-mutated high-grade chondrosarcoma (BMJ Open, PMID 28601826).

Immunotherapy

Immunotherapy uses the immune system to help destroy cancer cells. Research is looking at new ways to use immunotherapy as a treatment for bone cancer, including the following.

Immune checkpoint inhibitors work by stopping cancer cells from affecting immune system cells in our bodies. The immune system normally stops itself from attacking healthy cells in the body by having some cells make specific proteins called checkpoints. Cancer cells sometimes use these checkpoints to avoid being attacked by the immune system. Immune checkpoint inhibitors are monoclonal antibodies that work by blocking checkpoint proteins so T cells (a type of white blood cell) can attack and kill cancer cells. Researchers are studying the following immune checkpoint inhibitors in early clinical trials to treat advanced bone cancers:

Dendritic cells are special immune cells in the body that help the immune system recognize cancer cells. An early study showed that dendritic cell therapy resulted in an immune response in people with refractory bone cancer, but it improved the outcome in only a small number of people (Cancer, PMID 28241093).

Targeted therapy

Targeted therapy uses drugs to target specific molecules (such as proteins) on or inside cancer cells. These molecules help send signals that tell cells to grow or divide. By targeting these molecules, the drugs stop the growth and spread of cancer cells while limiting harm to normal cells. The following is noteworthy research in targeted therapy for bone cancer.

Sorafenib (Nexavar) may be a treatment option for advanced chordoma. Results of a clinical trial show that sorafenib may improve progression-free survival, but more study is needed to find out what role it may have in treating this type of bone cancer (ASCO, Abstract 10520).

Tyrosine kinase inhibitors block a specific enzyme (called tyrosine kinase) that helps send signals within cells. When this enzyme is blocked, the cells stop growing and dividing. Researchers are looking at the following tyrosine kinase inhibitors in treating bone cancer that doesn't respond to other treatments:

mTOR inhibitors work by blocking mTOR, which is a protein that regulates cellular metabolism and growth and how quickly cells multiply. In early studies, researchers are looking for possible benefits of adding the following mTOR inhibitors to treatment regimens for advanced bone cancer:

  • ABI-009 (nab-sirolimus) with nivolumab for advanced chondrosarcoma, osteosarcoma and Ewing sarcoma (ASCO, Abstract 11057; ClinicalTrials.gov, NCT03190174)

  • sirolimus (Rapamune) with gemcitabine for advanced osteosarcoma (ASCO, Abstract 10530; Annals of Oncology, PMID 29045512)

Follow-up

Research is looking at ways to improve quality of life for cancer survivors. Lifelong follow-up is important for people who have bone cancer because the risk for late effects after treatment is very high and lasts for the rest of the person's life (Cancer, PMID 28222219).

Learn more about cancer research

Researchers continue to try to find out more about cancer. Clinical trials are research studies that test new ways to treat cancer. They also look at ways to prevent, find and manage cancer.

Clinical trials provide information about the safety and effectiveness of new approaches to see if they should become widely available. Most of the standard treatments for cancer were first shown to be effective through clinical trials.

Expert review and references

  • Amela E, Bompas E, Le Cesne A, Tresch E, Italiano A, Piperno-Neumann S, Collard O, et al . A phase II trial of sorafenib (SO) in advanced chordoma patients (pt). ASCO 2015 Annual Meeting. Alexandria, VA: American Society of Clinical Oncology; 2015.
  • Broto JM, Redondo A, Valverde CM, Vaz Salgado MA, Mora J, del Muro XG, Sancho Marquez MP, et al . Phase II trial of gemcitabine plus rapamycin as second line in advanced osteosarcoma: A Spanish Group for Sarcoma Research (GEIS) Study. ASCO 2015 Annual Meeting. Alexandria, VA: American Society of Clinical Oncology; 2015.
  • Carcano FM, dos Santos LV, Vidal DO, Lopes LF, da Silveria Nogeira Lima JP . Prognosis value of HER2 in osteosarcomas: A systematic review with meta-analysis. ASCO 2015 Annual Meeting. Alexandria, VA: American Society of Clinical Oncology; 2015.
  • Chawla NS . Sustained response of complex giant cell tumors with denosumab: single center 8-year experience. ASCO 2015 Annual Meeting. Alexandria, VA: American Society of Clinical Oncology; 2015.
  • Huang JF, Du WX, Chen JJ . Elevated expression of matrix metalloproteinase-3 in human osteosarcoma and its association with tumor metastasis. Journal of BUON. 2016.
  • Liu Y, Teng Z, Wang Y, Gao P, Chen J . Prognostic significance of surviving expression in osteosarcoma patients: a meta-analysis. Medical Science Monitor. International Scientific Information, Inc; 2015.
  • Lugowska I, Mikula M, Teterycz P, Kulecka M, Kluska A, Piatkowska M, et al . IDH mutations to predict shorter survival in chondrosarcoma. ASCO 2016 Annual Meeting. Alexandria, VA: American Society of Clinical Oncology; 2016.
  • Palmerini E, Picci P, Marchesi E, Staals EL, Cesari M, Longhi A, Paioli A, et al . High dose ifosfamide in metastatic high-grade osteosarcoma, after failure of standard multimodal chemotherapy. ASCO 2015 Annual Meeting. Alexandria, VA: American Society of Clinical Oncology; 2015.
  • van de Luijtgaarden AC, Kapusta L, Bellersen L, Bokkerink JP, Kaal SE, Versleijen-Jonkers YM, et al . High prevalence of late adverse events in malignant bone tumour survivors diagnosed at adult age. Netherlands Journal of Medicine. 2014.
  • Yu H, Yu J, Ren Y, Yang Y, Xiao X . Serum CEACAM1 level is associated with diagnosis and prognosis in patients with osteosarcoma. PLoS One. 2016.