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Research into primary bone cancer

Find out about the latest UK research and clinical trials looking at bone cancer.

Understanding bone cancer cells

How cells work

Scientists are studying the processes that take place within the cells of the body. They hope to understand exactly how the cells work. They want to find out what goes wrong when a normal cell becomes a cancer cell. 

One aim of this research is to find the causes of bone cancer at the cell level. It might lead to new treatments that have fewer and less severe side effects than current treatments. 

Genetic changes

Cancer starts when gene changes make one cell or a few cells grow and multiply too much. These gene changes are called a genetic signature. A small number of cells with a genetic signature can be found in the blood of someone with a sarcoma.  

Researchers did a study in people with bone cancer. They took blood samples to look for genetic signatures. Using the signature they want to develop a test. They hope it will show how well treatment is working or if the cancer has come back.

Chemotherapy

Doctors continue to study different:

  • combinations of chemotherapy drugs 
  • doses of chemotherapy drugs
  • sequences in which the drugs are given

The aim is to find the most effective way of treating bone cancer with chemotherapy.

Drug combinations

Researchers looked at adding the drugs ifosfamide and etoposide to the usual chemotherapy for osteosarcoma. It was for people who had surgery and were at a high risk of their cancer coming back. They found that adding these 2 drugs didn't work any better and the side effects were worse. 

Other trials are also comparing different combinations of chemotherapy before and after surgery or radiotherapy for Ewing's sarcoma. 

Side effects

Some researchers are looking at reducing the side effects of chemotherapy. One trial looked at using a drug called glucarpidase to reduce the side effects of methotrexate. This trial has closed and we are waitng for the results.

What happens to the drug inside the body can also affect how well it works and how bad the side effects are. This might depend on the age, sex, height and weight of the person. Researchers have measured the levels of chemotherapy drugs in the blood. They looked at how well the drugs worked and also at the side effects.

Targeted cancer drugs

Targeted cancer drugs use the body's natural substances to control the growth of cancer cells or attack them. There are different types of targeted cancer drugs that work in different ways.

For primary bone cancer, researchers are looking at:

  • interferon, which stimulates the body's immune system
  • mifamurtide, which also boosts the immune system and helps to kill cancer cells
  • deforolimus, which blocks the signals that tell cancer cells to divide and grow

Interferon

Researchers added interferon to the usual chemotherapy after surgery for osteosarcoma. This trial was for people with a low risk of their bone cancer coming back. They found that adding interferon wasn't any better than the chemotherapy alone.

Mifamurtide

Doctors already give mifamurtide with chemotherapy after surgery for some people with osteosarcoma. Researchers are looking at giving mifamurtide for osteosarcoma that has come back after treatment and can't be removed with surgery (advanced osteosarcoma). They want to find out if it can help people with advanced osteosarcoma and to learn more about the drug.

Deforolimus

Researchers wanted to know if deforolimus could stop bone cancer coming back after chemotherapy. They found that it did for a short time in a small number of people who had benefited from having chemotherapy. But after a longer follow up, there wasn't a significant difference between people who had deforolimus and those who didn't.

Further research is going on to find how well these drugs work and what their side effects are.

Radiotherapy

Radiotherapy uses high energy waves like x-rays to kill cancer cells. Intensity modulated radiotherapy (IMRT) is a way of targeting the radiotherapy more precisely. This means less of the surrounding healthy tissue is affected.  

Researchers are looking at using IMRT to treat bone cancer. They want to find how well IMRT works and what the side effects are. 

High intensity focused ultrasound

High intensity focused ultrasound (HIFU) uses high frequency sound waves to kill cancer cells. Researchers are looking at using HIFU for people with bone cancer of the lower spine. They want to find how well it works and what the side effects are. 

Scans

MRI scans

MRI stands for magnetic resonance imaging. It uses magnetism and radio waves to create cross section pictures of the body. It produces pictures from angles all around the body and shows up soft tissues very clearly.

Researchers are looking into whether MRI scans are as good as CT scans at measuring how well chemotherapy is working in people with Ewing's sarcoma or osteosarcoma. And if the MRI scans can pick up how well chemotherapy is working sooner than CT scans.

Other scans

Researchers are also looking at other types of scans such as PET-CT scans before surgery for primary bone cancer to see if they can show up how well a cancer is responding to chemotherapy.

MR guided focused ultrasound for bone pain

Doctors can treat bone pain caused by cancer with radiotherapy. But researchers think that MR (Magnetic resonance) guided focused ultrasound may work as well as radiotherapy. It uses high frequency sound waves to treat the areas of cancer in the bone. The researchers want to know if it treats bone pain caused by cancer and how safe it is to use.

Last reviewed: 
05 Dec 2017
  • Comparison of MAPIE versus MAP in patients with a poor response to properative chemotherapy for newly diagnosed high grade ostesarcoma (EURAMOS-1): an open-label, intervention, randomised controlled trial
    N M Marin and others
    Lancet Oncology, August 25, 2016

  • MAP plus maintenance pegylated interferon a-2b (MAPIfn) versus MAPalone in patients with resectable high-grade osteosarcoma and good histologic response to preoperative MAP: First resutls of the EURAMOS-1 "good response" randomization
    S S Bielack and others
    Journal of Clinical Oncology 2013 (suppl;abstr: LBA10504)

  • Clinical Trials Database
    Cancer Research UK 

  • UK guidelines for the management of bone sarcomas
    C Gerrand and others
    Clinical Sarcoma Research, 2016. Volume 6

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