Bone Metastases Treatment
Bone metastases (bone mets) are areas of cancer that have spread from a primary tumor (where your cancer first started) to the bone. Bone mets are often treated by treating the primary cancer and with other medication options, discussed below.
Treatment Options
Often, the most important treatment for bone metastases is treatment for the primary cancer (the original cancer). Chemotherapy, radiation, or other therapies may be used. Some therapies don’t treat the cancer itself, but focus on improving symptoms and quality of life. Pain management and Physical therapy (PT) to help you with daily tasks.
Besides treating the primary cancer, there are two main types of treatment for bone mets:
- Systemic therapies affect your whole body.
- Local treatments only affect one part of your body.
You may be given more than one type of treatment.
Systemic Therapies
Systemic therapies affect your whole body. They are given by mouth or given directly into a vein (IV, intravenously) where they travel through the bloodstream to cancer cells to kill them. Systemic treatment can cause side effects but can be a good way to help fight cancer throughout your whole body.
Medical Therapies
Chemotherapy, targeted therapy, immunotherapy, and hormone therapy are medications that travel throughout the body to kill cancer cells. Because metastatic cancer cells have broken off from the original tumor and are somewhere else inside your body, these medications may be able to get to the cancer cells and kill them. There are side effects of these medical therapies and you should talk to your provider about which treatment is best for you.
Bisphosphonates
Bisphosphonates are medications that are given directly into a vein (intravenously, IV).
These medications can help make diseased bones stronger and can help prevent fractures (breaks). Bisphosphonates may be used with other therapies to treat bone metastasis. This type of medication is often used to treat osteoporosis (a form of bone thinning not related to cancer). Bisphosphonates can help bones affected by cancer by helping them hold on to calcium, making them stronger. This slows down bone damage caused by the cancer, lowers high blood calcium levels (hypercalcemia), and lessens the risk of fracture.
Bisphosphonates are more effective for lytic (bone weakening) than blastic (bone thickening/hardening) types of metastases.
Bisphosphonates that are most often used are zoledronate (Zometa®) and pamidronate (Aredia®). Possible side effects are feeling tired, nausea, vomiting, lack of appetite, low blood calcium levels, and a rare side effect called osteonecrosis of the jaw.
Targeted Therapy
The medication denosumab (Xgeva®) is a targeted therapy and may be used to prevent more bone damage from cancer cells. It works by targeting a certain protein called RANKL that is needed for bone to break down. By targeting RANKL, denosumab stops the breakdown of bone and lowers the chance of a fracture in the affected bone. This medication has side effects much like bisphosphonates, but is more likely to cause low blood calcium. You may need to take calcium and vitamin D supplements while on this treatment.
Radionuclide Therapy
A radionuclide is an element that is radioactive. The medication is given intravenously (IV, into a vein) and goes into the areas of bone that have cancer. The radiation gives off over some time, killing the cancer cells and helping with pain. The treatment is given once, but the effect can last for a few months. Samarium and strontium are the most used radionuclides for bone metastases, but radium may also be used.
Radionuclides are more effective for blastic metastases, those that make more bone. This treatment can cause pain to get worse before it gets better. The main side effect is low blood counts. Radiation will be in your body for days to weeks, so you may need to change your activity level and limit time around other people. Your provider will talk to you about instructions for after your therapy.
Local Therapies
Local treatments affect only one part of your body. They focus on one area of cancer instead of all the cancer in your body.
Radiation Therapy
Radiation therapy uses high-energy X-rays to kill cancer cells. It is often used when you have bone pain from a metastasis that is not helped with pain medication. Most patients will have less pain, but it can take a few weeks for the full effect.
Ablation
Ablation is when a needle is placed into the tumor. This needle is used to put heat, cold, or a chemical into the tumor to kill cancer cells. Two common types of ablation are:
- Radiofrequency ablation uses an electric current to make heat that kills the tumor.
- Cryoablation freezes the tumor and kills cancer cells.
You will likely be given anesthesia (medication to help you sleep) for an ablation.
Bone Cement
In some cases, a bone may need to be made stronger or more stable. This can be done using a quick-setting cement or glue. A treatment called kyphoplasty or vertebroplasty is used to treat fractures caused by bone mets. Cement is injected into the bone to stabilize it. These can be used alone or can be used with other treatments such as radiation or radiofrequency ablation
Surgery
Surgery can be used to help with symptoms, such as pain, and to stabilize the bone or bones. Surgical rods, screws, pins, plates, and cages can be used to stabilize bones and prevent or treat fractured bones.
Clinical Trials
Clinical trials are designed to determine the value of specific treatments. Trials are often designed to treat a certain stage of cancer, either as the first form of treatment offered or as an option for treatment after other treatments have failed to work. They can be used to evaluate medications or treatments to prevent cancer, detect it earlier, or help manage side effects. Clinical trials are very important in helping us learn more about the disease. It is through clinical trials that we know what we do today, and many exciting new therapies are currently being tested. Talk to your provider about participating in clinical trials in your area. You can also explore currently open clinical trials using the OncoLink Clinical Trials Matching Service.
There are many different types of treatments for bone mets. Talk to your provider about your options and what would be best for you.