Bone Metastases Treatment
Bone metastases (bone mets) are cancer that has spread from a primary tumor (where your cancer first started) to the bone. Treatment for bone mets can include a number of treatments, including treatment of the primary cancer. This article details other treatments used for bone mets.
Most providers believe the most important treatment for bone metastases is treatment for the primary cancer (the original cancer). This may include chemotherapy, radiation, or other therapies. Some therapies don’t treat the cancer itself but focus on improving symptoms and quality of life. You may benefit from pain management to help you function better. Physical therapy (PT) may help you stay mobile and complete your daily activities.
Besides treating the primary cancer, there are two general types of treatment for bone mets: Systemic and local.
- 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, which are detailed below.
Systemic therapies affect your whole body. They are given by mouth or given directly into a vein (IV, intravenously), where they travel through the blood stream to cancer cells to kill them. Systemic treatment can cause side effects but can be a good way to manage cancer throughout your whole body.
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 what treatment is best for you.
Bisphosphonates are medications that can help make diseased bones stronger and can help prevent fractures (breaks). Bisphosphonates may be used along with other therapies for bone metastasis. This class 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 (weakening) than blastic (thickening/hardening) types of metastases. They are given directly into a vein (intravenously, IV).
The most commonly used bisphosphonates are zoledronate (Zometa®) and pamidronate (Aredia®). Possible side effects are tiredness, nausea, vomiting, lack of appetite, low blood calcium levels, and a rare side effect called osteonecrosis of the jaw.
The medication denosumab (Xgeva®) is a targeted therapy and may be used to prevent further bone damage from cancer cells. It works by targeting a specific protein that is needed for bone breakdown to occur. By targeting this protein, called RANKL, denosumab stops the breakdown of bone and lowers the chance of a fracture in the affected bone. This medication has side effects similar to the bisphosphonates, though more likely to cause low blood calcium. You may need to take calcium and vitamin D supplements while on this treatment.
A radionuclide is an element that is radioactive. The medication is given intravenously (IV, into a vein) and deposits itself into the areas of bone that have cancer. The radiation gives off over a period of time, killing the cancer cells and lessening 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 limit your activity and time around other people. Your provider will talk to you about instructions for after your therapy.
Local treatments only affect one part of your body. They focus on managing one area of cancer instead of all the cancer in your body.
Radiation therapy is the use of high-energy x-rays to kill cancer cells. It is often used when you have bone pain from a metastasis that is not relieved with pain medication. Most patients will have less pain, but it can be a few weeks after treatment before maximum pain relief happens.
Ablation is when a needle is placed directly into the tumor. This needle is used to introduce heat, cold, or a chemical into the tumor to kill cancer cells. The two commonly used types of ablation are radiofrequency ablation and cryoablation.
- Radiofrequency ablation uses an electric current that makes heat to destroy the tumor.
- Cryoablation freezes the tumor and kills cancer cells.
You will likely be given anesthesia (medication to help you sleep) while having an ablation done.
In some cases, a bone may need to be strengthened or stabilized. This can be done using a quick-setting cement or glue. A procedure called kyphoplasty or vertebroplasty is used to treat fractures caused by bone mets. This involves the injection of cement to stabilize the bone. These can be used alone or can be used with other treatments such as radiation or radiofrequency ablation
Surgery can be used to relieve 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 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 extremely important in furthering our knowledge of this 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.
American Cancer Society. Treating Bone Metastases. Found at: https://www.cancer.org/treatment/understanding-your-diagnosis/advanced-cancer/treating-bone-metastases.html
Gnant M, Mlineritsch B, Schippinger W et al.: Endocrine therapy plus zoledronic acid in premenopausal breast cancer. N Engl J Med. 360(7),679–691 (2009).
Henry DH, Costa L, Goldwasser F, et al. Randomized, double-blind study of denosumab versus zoledronic acid in the treatment of bone metastases in patients with advanced cancer (excluding breast and prostate cancer) or multiple myeloma. J Clin Oncol. 2011;29(9):1125-32.
Tan, WW, et al. Bone Health and Breast Cancer Management Overview of Bone Health in Breast Cancer. Emedicine.com May 25, 2016.
The Lancet. Adjuvant bisphosphonate treatment in early breast cancer: meta-analyses of individual patient data from randomised trials. 2015. 366(10001):1353-1361.
Van Poznak CH, Temin S, Yee GC, et al. American Society of Clinical Oncology executive summary of the clinical practice guideline update on the role of bone-modifying agents in metastatic breast cancer. J Clin Oncol. 2011;29(9):1221-7.
West, H. Denosumab for prevention of skeletal-related events in patients with bone metastases from solid tumors: incremental benefit, debatable value. J Clin Oncol. 2011;29(9):1095-8.