Chemotherapy for bone cancer

Chemotherapy uses anti cancer (cytotoxic) drugs to destroy cancer cells. The drugs circulate throughout the body in the bloodstream.

This page is about cancer that starts in your bone (primary bone cancer).

If your cancer has spread into bone from another part of the body, it is called secondary or metastatic bone cancer.

When you might have chemotherapy

Chemotherapy works very well for some types of bone cancer, particularly Ewing sarcoma. You often have chemotherapy for osteosarcoma or spindle cell sarcoma as well. There are different reasons why you might have chemotherapy treatment.

This is to try and shrink the cancer before surgery. This makes it easier for your surgeon to completely remove it. It might mean it is possible for you to have limb sparing surgery, rather than an amputation.

You might have chemotherapy after surgery to try to reduce the risk of the cancer coming back.

Or you might have chemotherapy if your surgeon could not remove all of the bone tumour. Chemotherapy can shrink cancer that has been left behind. But even if chemotherapy shrinks it completely there is a high risk of it coming back some time in the future.

You might have chemotherapy with radiotherapy if you have Ewing sarcoma that can't be completely removed with surgery.

Some children and young adults with osteosarcoma might have chemotherapy with a type of targeted cancer drug called mifamurtide. This isn't a common treatment.

Treatment to control symptoms is called palliative treatment. You might have palliative chemotherapy to try and shrink the cancer, slow it down and relieve any symptoms that you have.

You might have chemotherapy for bone cancer as part of a clinical trial. Researchers are interested in the side effects that treatment for bone cancer causes and new ways of giving treatment.

Types of chemotherapy for bone cancer

There are many different drugs to treat bone cancer. You usually have a combination of drugs. 

Some of the common chemotherapy drugs for bone cancer are:

  • vincristine
  • ifosfamide
  • doxorubicin (Adriamycin)
  • etoposide
  • methotrexate
  • cisplatin
  • cyclophosphamide

The most common chemotherapy regime used to treat Ewing sarcoma is:

  • VDC/IE (vincristine, doxorubicin, cyclophosphamide, ifosfamide and etoposide)

High dose chemotherapy with stem cells

Very rarely you might have more intensive treatment. This is called high dose chemotherapy with stem cell rescue or stem cell transplant. You have this treatment if there is a high risk of your cancer coming back.

You have stem cells collected and stored until after your high dose chemotherapy. You then have the cells back into a vein so they can start to make new blood cells again.

There are different combinations of drugs for osteosarcoma. Doctors often use a chemotherapy regimen called MAP which lasts 5 weeks. This involves:

Day 1 (week 1)
  • cisplatin through a drip into your cannula or central line
  • doxorubicin through a drip into your cannula or central line
Day 2 (week 1)
  • cisplatin through a drip into your cannula or central line
  • doxorubicin through a drip into your cannula or central line
Day 22 (Week 4)
  • high dose methotrexate through a drip into your cannula or central line
  • folinic acid through a drip - to help control side effects
Day 29 (Week 5)
  • high dose methotrexate through a drip into your cannula or central line
  • folinic acid through a drip - to help control side effects

You have fluids before, alongside and after the chemotherapy. You also need frequent blood tests while you are having high dose methotrexate.

You are likely to have a similar treatment to those used for osteosarcoma. The dose might be reduced for older people.

If your osteosarcoma comes back after initial treatment you are likely to have treatment with:

  • ifosfamide and etoposide
  • docetaxel and gemcitabine

If your Ewing sarcoma comes back after treatment you are likely to have treatment with:

  • ifosfamide
  • etoposide
  • irinotecan and temozolamide
  • cyclophosphamide and topotecan
  • carboplatin and etoposide

We have specific information about each of these drugs on our cancer drugs A to Z list.

How you have chemotherapy

You have treatment through a thin short tube (a cannula) that goes into a vein in your arm each time you have treatment.

Or you might have it through a long plastic tube that goes into a large vein in your chest. This might be a:

  • central line
  • PICC line
  • Portacath

The tube stays in place throughout the course of treatment.

You might have some drugs as tablets.

Where you have chemotherapy

You usually have treatment into your bloodstream at the cancer day clinic. You might sit in a chair for a few hours so it’s a good idea to take things in to do. For example, newspapers, books or electronic devices can all help to pass the time. You can usually bring a friend or family member with you.

You have some types of chemotherapy over several days. You might be able to have some drugs through a small portable pump that you take home.

For some types of chemotherapy you have to stay in a hospital ward. This could be overnight or for a couple of days.

Before you start chemotherapy

COVID swab test

Due to coronavirus, you need to have a test to check for coronavirus before you have treatment. The test is called a COVID swab test.

To have the test your nurse takes a sample from the inside of your nose and the back of your throat. They use a long cotton bud to take the sample. Or the sample might be saliva or other fluid. Depending on which test your hospital uses, it can take from 90 minutes to a few days to get a result.

At most hospitals, you have a COVID swab test 48 to 72 hours (up to 3 days) before going for your treatment in the chemotherapy unit.

This means you might have the swab test on the same day that you visit the hospital for blood tests and your doctor’s clinic appointment. If you have treatment weekly or more often, some hospitals will ask you to have the swab test on the day of treatment.

Check with your team about when you’ll have the test as there are some differences between hospitals.

Blood tests

You need to have blood tests to make sure it’s safe to start treatment. You have these either a few days before or on the day you start treatment. You have blood tests before each round or cycle of treatment.

You might have a hearing test. You also might have an echocardiogram (ECHO) to check your heart function.

After each chemotherapy

After each chemotherapy treatment you usually have a break of a few weeks before you start the next cycle of chemotherapy. During your weeks off, your bone marrow replaces your blood cells. If your white cell count is slow to pick up or you are having intensive treatment, you may have drugs called growth factors. These help your bone marrow make blood cells more quickly.

You usually have growth factors as small injections just under the skin (subcutaneous injections). You usually have a type of growth factor called G-CSF.

Side effects

Common chemotherapy side effects include:

  • feeling sick
  • loss of appetite
  • losing weight
  • feeling very tired
  • a lower resistance to infections
  • bleeding and bruising easily
  • diarrhoea or constipation
  • hair loss
Contact your doctor or nurse immediately if you have signs of infection, including a temperature above 37.5C or below 36C, or generally feeling unwell. Infections can make you very unwell very quickly.

Side effects depend on:

  • which drugs you have
  • how much of each drug you have
  • how you react

Tell your treatment team about any side effects that you have.

Most side effects only last for a few days or so. Your treatment team can help to manage any side effects that you have.

When you go home

Chemotherapy for bone cancer can be difficult to cope with. Tell your doctor or nurse about any problems or side effects that you have. The nurse will give you telephone numbers to call if you have any problems at home.

Dietary or herbal supplements and chemotherapy

Let your doctors know if you:

  • take any supplements
  • have been prescribed anything by alternative or complementary therapy practitioners

It’s unclear how some nutritional or herbal supplements might interact with chemotherapy. They could be harmful.