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Bone cancer research

All treatments must be fully researched before they can be adopted as standard treatment for everyone. This is so that we can be sure they work better than the treatments we already use. And so we know that they are safe.

First of all, treatments are developed and tested in laboratories. They are only tested in people (in clinical trials) once we know they are safe enough. Cancer Research UK supports a lot of UK laboratory research into cancer and also supports many clinical trials.

There is research going on into treating bone tumours, including into chemotherapy, biological therapies, and radiotherapy during surgery.


CR PDF Icon You can view and print the quick guides for all the pages in the Treating bone cancer section.



Why we need research

All treatments have to be fully researched before they can be adopted as standard treatment for everyone. This is so that

  • We can be sure they work
  • We can be sure they work better than the treatments that are available at the moment
  • They are known to be safe

Here is a video on what it's like to take part in a clinical trial:

View a transcript of the video (Opens in a new window) 


The research process

First of all, treatments are developed and tested in laboratories. For ethical and safety reasons, experimental treatments must be tested in the laboratory before they can be tried in patients. If a treatment described here is said to be at the laboratory stage of research, it is not ready for patients and is not available either within or outside the NHS. Cancer Research UK supports a lot of UK laboratory research into cancer and also supports many clinical trials.

Clinical trials test treatments in patients. The trials and research section has information about what trials are, including information about the 4 phases of trials. If you are interested in taking part in a trial for bone cancer recruiting in the UK, visit our database of clinical trials. If you would like to take part in a particular trial, print off the page and take it to your own specialist. If the trial is suitable for you, your doctor will need to make the referral to the research team. The database also has information about closed trials and trial results.

All the new approaches covered here are the subject of ongoing research. Until studies are completed and new effective treatments are found, these treatments cannot be used as standard therapy for bone cancer.


Understanding bone cancer cells

Scientists are studying the processes that take place within the cells of our body. Through this research we hope to understand exactly how our cells work, so that we can then find out what goes wrong when a normal cell becomes cancerous. This research aims to find the causes of bone cancer at the cell level. The knowledge gained from this work may lead to new treatments with fewer and less severe side effects than current cancer treatments.

Cancers are made up of cells that grow and multiply quickly. They do this because they have a number of mistakes called mutations in their DNA. The gene changes are called a genetic signature. If there is a sarcoma in the body small numbers of cells with the genetic signature can be found in the blood. Each person has a different genetic signature. One study is trying to find out if it is possible to use a blood test to monitor people with sarcoma, which includes osteosarcoma, by looking for the faulty tumour DNA signature. They hope that the test can help them to know how well treatment is working or when a sarcoma has come back.



Doctors continue to study different combinations of chemotherapy drugs, different doses, or different sequences in which they are given. The aim of this type of research is to find more effective ways of treating bone cancers with chemotherapy.

The Euramos 1 trial has been looking at different combinations of treatment after surgery for osteosarcoma. Doctors usually treat it with methotrexate, doxorubicin (Adriamycin) and cisplatin (MAP chemotherapy) both before and after surgery. As part of the trial, after surgery, a pathologist looked at the tumour to see how well the chemotherapy was working. They split the group into people where MAP was working well (lower risk group) and those in whom it was working less well (high risk group).

In the lower risk group, some people had MAP chemotherapy after surgery as normal. The others had MAP plus an interferon injection every week for up to 18 months. After 3 years of follow up, the number of people free of osteosarcoma in these 2 groups were similar. The trial team concluded that so far having interferon after MAP chemotherapy doesn't appear to be any better than having MAP on its own. 

In the high risk group, some people had MAP chemotherapy after surgery, and some had MAP plus ifosfamide and etoposide (MAPIE). The trial team have not reported on this group of patients yet.

The EURO-EWING 99 trial for Ewing's sarcoma is comparing several different combinations of drugs before and after surgery and radiotherapy. This trial has closed and we are waiting for the results. There is now the Euro Ewing 2012 trial which is comparing different combinations of chemotherapy before and after surgery.

The rEECur trial is looking at 4 different types of chemotherapy to treat Ewing's sarcoma that didn't respond to treatment or has come back afterwards.

Some studies are looking at ways of reducing the side effects of chemotherapy. There is a study looking at using a drug called glucarpidase as well as folinic acid after methotrexate chemotherapy. This study is for people with osteosarcoma or spindle cell sarcoma. Researchers hope that glucarpidase will reduce the side effects of methotrexate such as a sore mouth, abdominal pain and an increased risk of infection. 

The AYAPK trial is looking at how your age, sex, stage of physical development, height and weight might affect how you process doxorubicin if you are being treated for osteosarcoma or Ewing's sarcoma. Another study is looking at what happens to chemotherapy drugs in the body during treatment for Ewing’s sarcoma. The researchers want to find out if the blood levels influence the side effects people have and their response to the drugs. They also want to find out how the blood levels vary in different age groups. This trial has now closed and we are waiting for the results.

You can find information about all these trials on our clinical trials database. Bone cancer trials may also be listed under 'sarcoma'.


Biological therapy

Biological therapies are treatments that use natural substances from the body, or that change the way cells signal to each other. They can stimulate the body to attack or control the growth of cancer cells. Interferon is a type of biological therapy that works by encouraging the body's natural defence system – the immune system – to attack cancer cells. The Euramos 1 trial has been testing interferon as a maintenance treatment after chemotherapy and surgery for osteosarcoma. Maintenance treatment means a long term treatment to help lower the risk of a cancer coming back after it has been surgically removed. The trial team concluded that so far having interferon after chemotherapy doesn't appear to be any better than having chemotherapy on its own. 

Another drug called deforolimus (also called AP23573) stops a protein called mTOR from working properly. mTOR is important because it controls other proteins that are needed for cells to grow. So if mTOR can't work, then neither can these other proteins. This may help to slow down or stop the cancer growing. The SUCCEED trial aimed to find out if deforolimus could control the growth of cancer and for how long. A group of patients had deforolimus, and a group of patients had a dummy drug (placebo). The trial team concluded that for a short period of time (3½ weeks) deforolimus did delay the sarcoma from growing again in a small number of people who had benefited from having chemotherapy.  But after 2 years of follow up there wasn’t a significant difference between the average overall time that people in the 2 groups lived. Deforolimus is not routinely used as a treatment in the UK. You can read a summary of the results of the SUCCEED trial on our clinical trials database. 

Early phase trials are looking at using insulin like growth factor inhibitors to treat Ewing's sarcoma. These block certain growth messages in cancer cells, so the cells stop growing. Early trials in small numbers of patients have shown that these drugs may slow or stop the growth of Ewing's sarcoma, but more research is needed before we know whether these treatments work.

The LINES trial is looking at a type of cancer growth blocker called linsitinib for advanced Ewing's sarcoma. The researchers want to find out more about how well it works and the side effects.

Another new treatment for oesteosarcoma is mifamurtide (Mepact). It helps to boost the body's immune system and kill cancer cells. You have it with chemotherapy after surgery. Research comparing chemotherapy with and without mifamurtide found that mifamurtide helped people to live longer. In August 2011 the Scottish Medicines Consortium (SMC) and the National Institute for Health and Care Excellence (NICE) said it should be available to have with chemotherapy within the NHS. It is for children and young adults who have a high grade osteosarcoma that has been removed with surgery.  

The MEMOS trial is looking at mifamurtide for osteosarcoma that has come back after treatment and cannot be completely be removed with surgery. The researchers want to see if the drug can help people with advanced osteosarcoma. They also want to understand why the drug works against some osteosarcomas, but doesn't help everybody.

There is information about biological therapies in our cancer treatments section.


Radiotherapy during surgery

This is a way of treating the cancerous bone with a very high dose of radiotherapy. Your doctor may call it extracorporeal (pronounced ex-tra-cor-por-ee-al) radiotherapy. This means radiotherapy given outside the body. You have an operation to remove the affected bone. Then, while you are still under anaesthetic, the radiotherapy team gives a very high dose of radiotherapy to the removed bone. This kills any cancerous cells. The surgeon then puts the treated bone back and fixes it in place. Doctors most commonly use this treatment for pelvic tumours, where making a false replacement part (prosthesis) is very difficult. You may have side effects because the bone has been removed, then given radiotherapy so when it is put back the bone is actually dead. Because radiotherapy also destroys normal cells, you may have breaks (fractures) or infections after this type of treatment.

Only a few centres use extracorporeal irradiation – those where the surgeon and radiotherapy team are experienced in using it and work closely together. There are very few clinical trials of this procedure. So this means there is little firm evidence about how well it works or what the long term effects are. If your specialist thinks this type of treatment could be suitable for you, they will talk through all the benefits and risks with you.


Radiofrequency ablation (RFA)

Radiofrequency ablation (RFA) uses heat made by radio waves to kill cancer cells. Radiofrequency is a type of electrical energy. Ablation means destroying completely. The electrical energy heats up the tumour and kills the cancer cells. It is used for some other types of cancer, such as liver cancer, lung cancer and kidney cancer. And it is also used for cancers that have spread to the lung (secondary lung cancer) and liver (secondary liver cancer). Doctors occasionally use RFA to treat bone cancer that has spread to the lungs or to other bones.


High intensity focused ultrasound (HIFU)

HIFU uses high frequency sound waves. Focusing these waves on a cancer can kill some of the cells. It is used for some other types of cancer such as prostate cancer, but researchers want to see if it helps some types of primary bone tumours. A trial is looking at HIFU for people with cancer that starts in the lower part of the spine. Chordomas and osteosarcomas can start in the lower part of the spine (the sacrum and coccyx).

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Updated: 23 January 2015