Chemotherapy for bone cancer

Chemotherapy uses anticancer (cytotoxic) drugs to destroy cancer cells. It is sometimes used to treat bone cancer. It is not used for low-grade bone cancers because it has not been shown to work well for those cancers. Your healthcare team will consider your personal needs to plan the drugs, doses and schedules of chemotherapy. You may also receive other treatments.

Chemotherapy is given for different reasons. You may have chemotherapy to:

• shrink a tumour before surgery (called neoadjuvant chemotherapy)
• destroy cancer cells left behind after surgery and reduce the risk that the cancer will come back (recur) (called adjuvant chemotherapy)
• destroy cancer cells in the body that have spread (metastasized) to other parts of the body

Chemotherapy is usually a systemic therapy. This means that the drugs travel through the bloodstream to reach and destroy cancer cells all over the body, including those that may have broken away from the primary tumour in the bone.

Chemotherapy is given for high-grade osteosarcoma. The same chemotherapy drug combinations that are used for high-grade osteosarcoma are also used for dedifferentiated chondrosarcoma and undifferentiated high-grade pleomorphic sarcoma.

Chemotherapy is given before surgery to shrink the bone tumour and to treat any cancer cells that may have started to spread in the body. If the cancer does not respond to the chemotherapy given before surgery, your healthcare team may use a different drug combination after surgery.

Most chemotherapy combinations for osteosarcoma include 2 or 3 drugs. Some combinations are given with a shorter time between treatments (called interval compressed chemotherapy).

The most common chemotherapy drug combinations used to treat osteosarcoma tumours are:

• cisplatin and doxorubicin (Adriamycin)
• high-dose methotrexate, cisplatin and doxorubicin
• ifosfamide (Ifex), cisplatin and epirubicin (Pharmorubicin)
• doxorubicin, cisplatin, ifosfamide and high-dose methotrexate

If an osteosarcoma does not respond to drugs used in earlier treatments or if it comes back, the following drugs may be used:

• gemcitabine (Gemzar)
• docetaxel (Taxotere) and gemcitabine
• cyclophosphamide (Procytox) and etoposide (Vepesid, VP-16)
• cyclophosphamide and topotecan (Hycamtin)
• high-dose ifosfamide, with or without etoposide
• ifosfamide, carboplatin (Paraplatin, Paraplatin AQ) and etoposide
• high-dose methotrexate, etoposide and ifosfamide

Chemotherapy combinations that use high-dose methotrexate are not used very often for adults who are 40 or older. This is because there is a higher chance that the kidneys will not move the drug out of the body quickly enough, which can cause serious side effects.

Chemotherapy is not used for low-grade chondrosarcoma tumours because it usually does not work well or make a prognosis better.

Mesenchymal chondrosarcoma tumours are an aggressive, high-grade type of chondrosarcoma tumour. They may be treated with one of the following drug combinations:

• vincristine (Oncovin), doxorubicin (Adriamycin) and cyclophosphamide, alternating treatments with ifosfamide and etoposide
• vincristine (Oncovin), doxorubicin (Adriamycin), ifosfamide (Ifex) and dactinomycin (Cosmegen)

If mesenchymal chondrosarcoma has already spread (metastasized) by the time it is diagnosed, the following drug combination may be used:

• vincristine, doxorubicin and cyclophosphamide

Chemotherapy may be offered for chordoma if the cancer has spread into the surrounding tissues, if it cannot be removed by surgery or if it has spread to other parts of the body.

The most common chemotherapy drugs used to treat chordoma are:

• imatinib (Gleevec)
• doxorubicin

The most common chemotherapy drug combinations used to treat chordoma are:

• imatinib and cisplatin
• doxorubicin and cisplatin

Side effects can happen with any type of treatment for bone cancer, but everyone’s experience is different. Some people have many side effects. Other people have few or none at all.

Chemotherapy may cause side effects because it can damage healthy cells as it kills cancer cells. If you develop side effects, they can happen any time during, immediately after or a few days or weeks after chemotherapy. Sometimes late side effects develop months or years after chemotherapy. Most side effects go away on their own or can be treated, but some side effects may last a long time or become permanent.

Side effects of chemotherapy will depend mainly on the type of drug, the dose, how it’s given and your overall health. Some common side effects of chemotherapy drugs used for bone cancer are:

• nausea and vomiting
• low blood cell counts
• diarrhea
• constipation
• fatigue
• sore mouth and throat
• loss of appetite
• hair loss
• skin problems, such as a rash or redness
• peripheral nerve damage

Tell your healthcare team if you have these side effects or others you think might be from chemotherapy. The sooner you tell them of any problems, the sooner they can suggest ways to help you deal with them.

Details on specific drugs change regularly. Find out more about sources of drug information and where to get details on specific drugs.

Find out more about chemotherapy and side effects of chemotherapy. To make the decisions that are right for you, ask your healthcare team questions about chemotherapy.