Bone Metastasis Treatment

Bone metastasis occurs when cancer cells spread from their original site to bone. Unlike primary bone cancer, which begins in bone tissue, metastatic bone cancer develops when cancer cells break away from a tumor elsewhere in the body, travel through the bloodstream or lymphatic system and form new tumors in the skeleton.

Bone is one of the most common sites of cancer spread. Bone metastases are most frequently linked to breast, prostate and lung cancers, although many other types of cancer can also spread there. Because cancer treatments continue to improve and patients are living longer, more people are being diagnosed with metastatic disease, including cancer that has spread to the bones.

When cancer cells invade bone tissue, they can interfere with the normal processes that help keep the bones strong. Some metastases can destroy bone, making it weaker and more likely to fracture, while others may cause abnormal bone formation. Both types can compromise the structural strength of the bone and lead to complications.

The symptoms of bone metastasis can vary based on its location and extent. Persistent or worsening bone pain is the most common sign. Some patients also experience fractures, even after minor trauma. If the spine is affected, pressure on the spinal cord may cause numbness, weakness or difficulty walking. High calcium levels in the blood may also occur, leading to fatigue, nausea or confusion. In some cases, bone metastases are found on imaging tests before symptoms develop.

The goals of bone metastasis treatment are to relieve pain, prevent fractures and other complications and control the underlying cancer. Treatment is individualized based on the primary tumor type, the extent of cancer spread and the patient’s overall health and goals.

With surgery, we can stabilize the bone by placing a rod inside the bone or adding a plate. Even if it’s in the leg, most patients are walking and go home the next day

David Joyce, MD

Sarcoma Program

Surgery for bone metastasis

Surgery may be recommended for bone metastasis that is causing significant pain, structural instability or recurrent fractures. It may also be considered to stabilize a bone that is at high risk of breaking or to relieve pressure on the spinal cord.

Surgical treatment for bone metastasis may involve:

• Internal fixation with rods, plates or screws to stabilize a weakened bone
• Joint replacement, such as a hip replacement, if the joint is severely damaged
• Vertebroplasty or kyphoplasty to stabilize a spinal fracture
• Surgical decompression to relieve pressure on the spinal cord

The risks and side effects of surgery for bone metastasis can include infection, bleeding, blood clots, delayed wound healing and complications related to anesthesia. Recovery time can vary depending on the procedure performed and the patient’s overall health.

Chemotherapy for bone metastasis

Chemotherapy uses powerful cancer-fighting drugs to destroy rapidly dividing cells throughout the body. Because chemo circulates in the bloodstream, it is considered a systemic therapy. This treatment approach may be recommended if bone metastasis is part of more widespread cancer or if the primary tumor is known to respond well to these medications.

Chemotherapy drugs that may be used to treat cancer that has spread to bone include:

• Carboplatin
• Cisplatin
• Docetaxel
• Doxorubicin
• Paclitaxel

The specific drug regimen will be tailored to the type of primary cancer and other individual factors.

The side effects of chemotherapy can include fatigue, nausea, vomiting, hair loss, increased risk of infection, anemia and changes in appetite. Many side effects can be managed with supportive medications and close monitoring.

Radiation therapy for bone metastasis

Radiation therapy uses high-energy beams to target and destroy cancer cells in a specific area of the body. This localized treatment may be used to help relieve bone pain, reduce the size of a tumor and prevent fractures or spinal cord compression.

Radiation delivery techniques that may be used for bone metastasis include:

• External beam radiation therapy (EBRT)
• Intensity-modulated radiation therapy (IMRT)
• Radiopharmaceuticals, which deliver radiation through the bloodstream
• Stereotactic body radiation therapy (SBRT)

Radiation therapy can be highly effective for pain relief, with many patients experiencing improvement within a few days to weeks. Potential side effects can vary depending on the treatment site and radiation dose, but may include skin irritation, fatigue, temporary worsening of pain and low blood cell counts.

Immunotherapy for bone metastasis

Immunotherapy aims to help the body’s immune system recognize and attack cancer cells. It may be considered for certain types of cancer that have spread to bone, particularly if the tumor expresses specific biomarkers.

Depending on the type of primary cancer, immunotherapy drugs that may be used for bone metastasis include:

• Atezolizumab
• Ipilimumab
• Nivolumab
• Pembrolizumab

Immunotherapy can produce a durable response in some patients. However, the activated immune system can sometimes target healthy tissues, which may lead to effects involving the skin, gastrointestinal tract, liver, lungs or endocrine glands. These complications require prompt medical attention.

Hormone (endocrine) therapy for bone metastasis

Some cancers, including certain types of breast and prostate cancer, rely on hormones to grow. Endocrine therapy aims to block the body’s production or use of those hormones, which can slow the progression of the cancer.

Depending on the type of primary cancer, hormone therapy options for bone metastasis may include:

• Androgen deprivation therapy
• Anti-androgen medications
• Aromatase inhibitors
• Tamoxifen

The side effects of hormone therapy can vary, but may include hot flashes, fatigue, decreased bone density, weight changes and mood swings.

Targeted therapy for bone metastasis

Targeted therapy focuses on the specific genetic mutations or proteins that help cancer cells grow. This treatment approach may be considered for bone metastasis if molecular testing identifies actionable drug targets.

Depending on the type of primary cancer, targeted therapy for bone metastasis may involve:

• HER2-targeted therapies for certain breast cancers
• EGFR inhibitors for some lung cancers
• BRAF inhibitors for melanoma

Additionally, bone-targeted therapies, such as bisphosphonates and denosumab, may be prescribed to strengthen the bones and reduce the risk of fractures and other skeletal-related events.

The side effects of targeted therapy can vary based on the specific drug and dose, but may include skin changes, diarrhea, high blood pressure and liver abnormalities.

Clinical trials for bone metastasis

Clinical trials are carefully designed research studies that evaluate emerging treatments or novel combinations of existing therapies. These studies are essential to advancing cancer care and improving outcomes for current and future patients.

Participation in a clinical trial may provide the patient with a unique opportunity to be among the first to benefit from a promising new therapy that could become the new standard of care. Patient safety is a top priority, and each participant is closely monitored by a dedicated research team throughout the study.

Benefit from world-class care at Moffitt Cancer Center

At Moffitt, patients with bone metastasis can receive comprehensive, multispecialty care tailored to their unique diagnosis and goals. Working closely together, specialists in medical oncology, radiation oncology, surgical oncology, orthopedic oncology, pain management and supportive care develop highly individualized treatment plans.

Moffitt is a National Cancer Institute-designated Comprehensive Cancer Center, a distinction that recognizes our scientific excellence and commitment to advancing cancer prevention, diagnosis and treatment. Our patients benefit from state-of-the-art technology, access to a robust portfolio of clinical trials and a compassionate team focused on both cancer control and quality of life.

If you would like to learn more about bone metastasis treatment, you can request an appointment with a specialist in the Sarcoma Program at Moffitt by calling 1-888-663-3488 or submitting a new patient registration form online. We do not require referrals.