Bone cancer 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

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.

Tests in patients are called clinical trials. 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, visit our database of clinical trials and choose 'bone cancer' from the drop down menu. If you are interested in a particular trial, print it off 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.

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. The BODIS study is trying to find out if it is possible to use a blood test to monitor people with sarcoma, 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 around the world are supporting research in hospitals and clinics to improve existing treatments for bone cancer. 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.

Clinical trials are looking into different combinations of chemotherapy drugs before and after surgery, to improve the outcome for people with bone cancer. A trial called Euramos 1 is looking at the response of osteosarcoma to different combinations of chemotherapy after surgery.

Clinical trials are also looking at using high dose chemotherapy and stem cell transplants for a type of bone cancer called Ewing's sarcoma. Doctors sometimes use high doses of chemotherapy to try and improve the chance of completely getting rid of the cancer. One current study for Ewing's sarcoma is comparing

• Vincristine, actinomycin D and ifosfamide (VIA)
• Vincristine, actinomycin D and cyclophosphamide (VAC)
• High dose busulfan, melphalan and stem cell rescue

Everyone in the trial first has treatment with a combination called VIDE (vincristine, ifosfamide, doxorubicin and etoposide). People who are expected to do well (have a good prognosis) then have less toxic treatment with either VIA or VAC. People who don't have such a good outlook either have VIA or the high dose busulfan treatment. This trial is trying to help doctors decide who needs which type of treatment. We could give everyone the most toxic treatment, but many people may not need it and so have unnecessary side effects. The links above take you to more information about the specific side effects of the drugs.

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, pain in the tummy (abdomen) and an increased risk of infection. 

You can find information about all these trials on our clinical trials database. Choose 'bone' from the dropdown list of cancer types. Bone cancer trials may also be listed under 'sarcoma'.

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 is 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.

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 could help to slow down or stop the cancer growing. The SUCCEED trial is looking into whether deforolimus can help to control osteosarcoma or Ewing's sarcoma that has spread, but has been shrunk or stopped from growing with chemotherapy. 

Early phase trials are looking at using insulin like growth factor inhibitors to treat Ewing's sarcoma. Insulin like growth factor inhibitors 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.

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 Clinical 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 oesteosarcoma that has been removed with surgery.  

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

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.