Chemotherapy drugs for bone cancer
This page tells you about the chemotherapy drugs used to treat cancer that started in the bones – primary bone cancer.
Chemotherapy drugs for bone cancer
Doctors use many different drugs to treat bone cancer. You usually have a combination of drugs.
The side effects of the drugs
All chemotherapy drugs have side effects. The ones you get depend on the drugs and dose you have and your body’s individual reaction. Some people have very few side effects, others have more.
Common side effects of chemotherapy include feeling or being sick, diarrhoea, tiredness, sore mouth, hair loss, loss of appetite and skin changes. It is also common to get a drop in your blood cell counts. This puts you at increased risk of infection and can also cause tiredness, shortness of breath and bleeding problems.
Fertility after chemotherapy
You may not be able to have children after treatment with some chemotherapy drugs. In other words, you could be infertile. If you are concerned about this, do talk to your doctor before you start the treatment. You may be able to have sperm, eggs or ovarian tissue frozen to help you have children in the future.
You can view and print the quick guides for all the pages in the Treating bone cancer section.
Many different drugs can be used to treat bone cancer. Usually a combination of drugs is used. Your doctor or chemotherapy nurse will give you written information about the drugs you are to have. Chemotherapy treatment plans are called regimens. The regimen includes the names of the particular drugs, when you should have them, and the dose you should have. Different regimens are used for different types of bone cancer. We know which treatments work best for each type from the results of clinical trials and from clinical experience.
You usually have the chemotherapy drugs over several days as an inpatient. You then have a break of a couple of weeks. This is called a cycle of treatment. You then start another cycle. A whole course of treatment is made up of a number of cycles – usually at least 6. With some types of chemotherapy you may go into hospital more than once during each treatment cycle. People with Ewing's sarcoma may have up to 14 cycles.
During the weeks off, your bone marrow replaces your blood cells. If your white blood cell count is slow to pick up or you are having intensive treatment, you may have drugs called growth factors to help your bone marrow make blood cells more quickly. You usually have growth factors as small injections, just under the skin (subcutaneous injections).
Your specialist will tell you which chemotherapy combination will suit you best. We have included details of some of the more common regimens here. Lower down this page, there is some information about general chemotherapy side effects.
There are several different treatments that can be used for Ewing's sarcoma. You are most likely to have 6 cycles of a regimen called VIDE. This includes the drugs
VIDE cycles take 3 weeks, so the whole course takes 18 weeks. You will often have surgery after the course of VIDE and then more chemotherapy, but usually with either the VIA or VAC regimen.
Both VIA and VAC take 3 weeks, and you usually have 8 cycles, so this is another 24 weeks of chemotherapy.
For some people, your doctor may suggest an experimental, more intensive treatment as part of a clinical trial for Ewing's sarcoma. This type of treatment is called high dose chemotherapy with stem cell rescue or stem cell transplant. Your specialist may suggest this if they think there is a high risk of your cancer coming back. With this type of treatment, you have to have some developing blood cells called stem cells collected and stored before the high dose chemotherapy. The stem cells are collected from a vein through a central line. You will need to have growth factor injections to encourage the bone marrow to make more stem cells. The high chemotherapy doses used in this type of treatment will kill off the cells in your bone marrow that make your blood cells.
Your stem cells are usually collected during your cycles of VIDE chemotherapy. They are frozen and stored until after the high dose chemotherapy. You then have the cells back into a vein so they can start to make new blood cells again. There is more information about high dose chemotherapy treatment in the cancer treatment section.
There are different combinations of drugs for osteosarcoma. A commonly used regimen has cycles of 5 weeks. On the first and second days, you have cisplatin and doxorubicin. Then you have a mid cycle break. At the beginning of the 3rd and 4th weeks, you have high dose methotrexate. To help control side effects, you have another drug through your drip called folinic acid for 2 to 3 days after your methotrexate treatment.
You have to stay in hospital when you are having the drugs in this regimen. You need fluids to flush out the cisplatin and you also need frequent blood tests (as well as the folinic acid) while you are having the high dose methotrexate. In between, you can go home but you may need to go back to the outpatient department for blood tests.
Spindle cell sarcomas include fibrosarcoma and malignant fibrous histiocytoma (MFH). The chemotherapy used for this type of bone cancer tends to be similar to that used for osteosarcoma, but the dose may be reduced for older people.
If osteosarcoma comes back after initial treatment you are likely to have ifosfamide and etoposide or docetaxel and gemcitabine treatment. If Ewing's sarcoma comes back after treatment you are likely to have ifosfamide, carboplatin and etoposide or irinotecan and cyclophosphamide treatment. Irinotecan and cyclophosphamide are used for children.
All chemotherapy drugs have side effects. The ones you get will depend on
- Which drugs you have
- How much of the drugs you have
- Your own individual reactions to the treatment
Some people have very few side effects. Others have far more. Unfortunately, we can’t tell before who will have trouble with side effects and who won’t.
If you know which drugs you will be having, you can go to the cancer drugs section and pick your drugs from the list. Among many other drugs, there are specific pages on the side effects of methotrexate, doxorubicin, ifosfamide, etoposide, vincristine, actinomycin D, cyclophosphamide, carboplatin and cisplatin.
Common side effects of chemotherapy for bone cancer include
- A drop in your blood cell counts, causing an increased risk of infection, anaemia and sometimes bleeding problems (nosebleeds, heavy periods, a rash of dark red spots)
- Feeling or being sick
- Sore mouth
- Hair thinning or hair loss
- Loss of appetite
- Skin changes
The links above take you to more information about these side effects and how to cope with them.
Your doctor and nurse can help with any side effects you do have. Anti sickness treatments are very effective and there are lots of different ones. If the anti sickness medication you are having is not helping, tell your chemotherapy nurse or doctor. They will be able to arrange for you to have something else that may work better for you. You can keep trying different anti sickness drugs until you find one that works for you.
Cisplatin and ifosfamide can cause nerve problems such as numbness and pins and needles. This nearly always gets better after the treatment is over. But you should tell your doctor about this as your drug dose may need adjusting. Cisplatin can also affect the kidneys and doxorubicin the heart. So you will have extra tests if you are having these drugs. Usually, these will be blood tests, but your doctor may want you to have heart tests – an electrocardiogram (ECG) and an echocardiogram (ECHO) – before you start treatment with doxorubicin. This is just to have a baseline reading of your heart function. You might need it repeated during and after your chemotherapy.
Some chemotherapy drugs can make you infertile. Infertile means you can't have children. But the chemotherapy used for bone cancer does not always cause infertility. Doctors are very aware that this is a very important issue when treating children and young people. They will always try to use drugs that do not cause fertility problems. But understandably, the main reason for selecting your treatment has to be the type of bone cancer you have and what is most likely to cure or control it.
Do ask your doctor about the effect that treatment will have on your fertility if you are worried. You may be able to have sperm, eggs or ovarian tissue frozen to increase your chances of having children in the future. There is more about this in the fertility and chemotherapy section.
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