Chemotherapy for Bone Cancer

Chemotherapy (chemo) is often an important part of treatment for Ewing sarcoma, osteosarcoma, and undifferentiated pleomorphic sarcoma (UPS).

It is not used as often for most other types of bone cancers, like giant cell tumors and most types of chordomas and chondrosarcomas. These cancers aren’t very sensitive to chemo, so other medicines might be tried first instead.

Chemo is the use of drugs to treat cancer. These drugs are usually given into a vein (IV) and can reach and destroy cancer cells anywhere in the body.

Note: This information focuses on bone cancers that are seen most often in adults and start in the bones (primary bone cancers). Osteosarcoma, Ewing sarcoma, and bone metastases are covered separately.

Which chemo drugs are used to treat bone cancer?

Some of the chemo drugs that can be used to treat bone cancer include:

• Doxorubicin (Adriamycin)
• Cisplatin
• Etoposide (VP-16)
• Ifosfamide
• Cyclophosphamide
• Methotrexate
• Vincristine
• Dactinomycin
• Topotecan
• Irinotecan
• Temozolomide
• Lurbinectidin
• Carboplatin
• Gemcitabine
• Docetaxel

In most cases, 2 or more drugs are given together. Some common combinations include:

MAP regimen: High-dose methotrexate, doxorubicin, and cisplatin, sometimes with ifosfamide and/or etoposide (MAPIE). This is most commonly used to treat osteosarcomas and undifferentiated pleomorphic sarcomas of the bone (UPS).

VDC/IE regimen: Vincristine, doxorubicin, cyclophosphamide, ifosfamide and etoposide. This combination is used most often to treat Ewing sarcoma.

Possible side effects of chemo

Chemo drugs affect cells that grow fast. While cancer cells grow fast, other healthy cells in the body do too. This includes blood-forming cells, hair cells, and cells that make up the lining of your gut. When chemo damages these fast-growing healthy cells, it can lead to side effects.

These side effects vary depending on the type of chemo drugs, the dose, and the length of time they are given. 

Your cancer care team will watch you closely for side effects. Don’t hesitate to ask questions.

Common short-term side effects

Some common short-term side effects of chemo drugs include:

• Nausea and vomiting
• Loss of appetite
• Diarrhea or constipation
• Hair loss
• Mouth sores

Chemo can damage your bone marrow, where new blood cells are made. This can lower your blood cell counts, leading to:

• Increased chance of infection (from having too few white blood cells)
• Easy bleeding or bruising (from low platelets)
• Fatigue or shortness of breath (from low red blood cells)

Controlling short-term side effects

To lower the risk of serious infections, drugs called growth factors (such as filgrastim, also known as G-CSF) are sometimes given along with chemo to help your body make new white blood cells as quickly as possible.

Most short-term chemo side effects go away after treatment is finished. Often there are ways to make these side effects less severe during treatment.

For example, you can take medicines to help prevent and reduce nausea and vomiting or to help your blood counts return to normal levels. Talk to your cancer care team if you have any questions about chemo side effects. Tell them about any side effects you have so they can help you control them.

Long-term side effects

Chemotherapy can also have some longer-term side effects.

For example, some drugs can increase the risk of later developing another type of cancer, such as leukemia. This risk is serious, but it isn’t common. The small increase in risk must be weighed against the importance of chemotherapy in treating bone cancers.

For more on the possible long-term effects of treatment, see After Treatment for Bone Cancer.

Side effects of specific chemo drugs

Some chemo drugs have specific side effects. For example: