Treatment of secondary bone cancer

The aim of treatment for secondary bone cancer is to control or shrink the cancer and relieve symptoms. This is called palliative treatment and may make you feel better.

Learn more about:

• What kind of treatment will you have?
• Radiation therapy
• Chemotherapy
• Targeted therapy
• Immunotherapy
• Hormone therapy
• Surgery
• Bone-strengthening drugs
• Palliative treatment
• Taking part in clinical trials

Radiation therapy

Also known as radiotherapy, radiation therapy uses targeted radiation to kill or damage cancer cells. The radiation is usually in the form of x-ray beams. Radiation therapy is often used to reduce pain in the bone. It is usually given from outside the body and is aimed at the particular bone causing pain.

The most common type of radiation therapy used for secondary bone cancer is external beam radiation therapy (EBRT). You will lie on a treatment table and a machine will deliver radiation to the affected area of the body. You may have one radiation therapy treatment, or several over a few days or weeks.

A type of EBRT called stereotactic body radiation therapy (SBRT) may also be used for secondary bone cancer. This is also known as stereotactic ablative body radiation therapy (SABR). You will lie on a treatment table and a machine will precisely deliver a few high doses of radiation to the bones. SBRT is offered in some specialised centres.

Depending on the cancer type, you may be injected with a small amount of radioactive liquid. This is known as radionuclide therapy (theranostic therapy). The liquid spreads throughout the body particularly targeting cancer cells. Your treatment team will let you know of any safety measures you need to follow.

Side effects – These relate to the type of cancer and the part of the body treated. They include fatigue, skin problems, hair loss, low blood cell counts, appetite loss and nausea.

Learn more about radiation therapy.

Chemotherapy

Chemotherapy uses drugs to kill or slow the growth of cancer cells, while causing the least possible damage to healthy cells.

Generally, chemotherapy is given through a vein (intravenously) over several hours, or as an injection between the skin and the muscle, or sometimes as a tablet (orally). Most people have several treatment cycles with rest periods in between. The number of sessions will vary depending on the drugs prescribed by your doctor and the type of primary cancer.

Side effects – These will depend on the chemotherapy drugs you receive. Common side effects include fatigue, nausea, diarrhoea, appetite loss, hair loss and increased risk of infections.

Learn more about chemotherapy.

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Targeted therapy

Targeted therapy uses drugs that attack certain features – genes or proteins – in the cancer cells to stop the cancer growing and spreading. The type of drugs you have will depend on the primary cancer.

Targeted therapy drugs can be given in different ways, including:

• as tablets that you swallow (orally)
• by injection under the skin (subcutaneously)
• by injection into a vein (intravenously).

Side effects – These will vary depending on the drugs used and how your body responds. Targeted therapy drugs often cause skin problems, such as dry, flaky skin and skin rashes. Other common side effects include fever, tiredness, joint aches, nausea, diarrhoea and headaches.

Learn more about targeted therapy.

Immunotherapy

Immunotherapy is a type of drug treatment that uses the body’s own immune system to fight cancer. The most common immunotherapy used to treat secondary bone cancer is checkpoint inhibitor drugs.

Some cancers block the immune system by creating “checkpoints”. Checkpoint inhibitor drugs allow the immune system to recognise and attack cancer cells, bypassing these checkpoints.

Several checkpoint inhibitor drugs are approved to treat some types of cancer that have spread to the bone, such as melanoma, lung, bladder and kidney cancers. Clinical trials are testing checkpoint immunotherapy for other cancer types.

Side effects – These will depend on the type of treatment you receive and how your body responds. Common side effects of immunotherapy are fatigue, dry eyes, rashes and diarrhoea.

Learn more about immunotherapy.

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Hormone therapy

Hormone therapy, also called endocrine therapy, may be used to treat breast or prostate cancer that has spread to the bone. Synthetic hormones which have been produced in a laboratory are given as tablets or injections to slow or stop the effect of the body’s natural hormones. The aim is to reduce the amount of hormones reaching the cancer cells. This can help to slow down the growth and spread of the cancer.

Side effects – Common side effects include hot flushes, mood changes, weight changes and sweating. Some types of hormone therapy can also weaken your bones, and affect your sex drive.

Surgery

Cancer can weaken bones and cause fractures. Surgery using metal rods or prostheses can be used to stabilise a fracture, or to strengthen bones which are at risk of fracturing. Surgery may also be used if the cancer is pressing on the spinal cord and causing weakness in the arms or legs.

Side effects – After surgery, some people develop an infection at the wound site. Your surgeon will discuss ways to prevent this happening.

Learn more about surgery.

Bone-strengthening drugs

Your doctor may prescribe medicines to help strengthen your bones, reduce bone pain and control high calcium levels in the blood (a condition known as hypercalcaemia).

There are two options for bone-strengthening drug treatment:

• bisphosphonates – a group of drugs that can be given as an injection into a vein (intravenously) or taken as a tablet (orally)
• denosumab – given as an injection under the skin (subcutaneously).

Side effects – These will vary depending on how the drugs are taken. Bisphosphonates taken intravenously can cause muscle and joint pain, fatigue, nausea or flu-like symptoms, such as a sore throat, shivering and fever.

Bisphosphonates taken orally may make your throat sore, or cause indigestion or nausea. Occasionally, bisphosphonates can cause kidney damage. Your kidney function will be monitored with regular blood tests.

Side effects of denosumab are uncommon but can include nausea, fatigue, diarrhoea, constipation and bone, joint and muscle pain.

All bone-strengthening drugs can lower calcium levels, so your doctor may advise you to take calcium and vitamin D supplements.

A rare but severe side effect of bone-strengthening drugs is the breakdown of bone tissue in the jaw. Called osteonecrosis of the jaw or ONJ, this may happen after the removal of a tooth.

See a dentist before starting to take bone-strengthening drugs, and then every 6 months while taking these drugs. If you need to have dental work during treatment, let your dentist know that you are taking bone-strengthening drugs and ask your oncologist if you can have a break in treatment.

See your doctor if you experience mouth ulcers, mouth pain or jaw problems while taking bone- strengthening drugs.

→ READ MORE: Managing symptoms of secondary bone cancer

Medical Oncologist Dr Elizabeth Hovey explains what clinical trials are and how they can improve cancer treatment.