Bone Cancer Treatments: Advances Show Promise

Cancer that starts in the bones, also known as primary bone cancer, makes up fewer than 1% of all cancer types. While rare, the American Cancer Society says that when you include cancers that start in other organs and spread to the bones (bone metastasis), those numbers grow much higher.

Good news: The five-year survival rates for primary bone cancers that remain in the bone have improved to about 70%. And with all of the clinical and technological advances available, cancer survivors have more options.

Francis J. Hornicek, M.D., Ph.D. is the director of orthopedic oncology, co-leader of the Sarcoma Multidisciplinary Care Group and director of Chordoma Program and Spine Oncology at Sylvester Comprehensive Cancer Center, as well as chair of the department of orthopaedics at the University of Miami Miller School of Medicine.

While surgery and chemotherapy are the go-to treatments for osteosarcoma, the most common primary bone cancer, Dr. Hornicek says advances in medications, certain surgical procedures, and technology are promising a brighter future for patients.

Recent studies have shown that certain medications may effectively improve bone cancer outcomes.

Drugs that prevent bone loss, such as zoledronic acid (Zometa) and denosumab (Xgeva), may help some bone cancer patients by strengthening the bones and reducing complications such as fractures. Zoledronic acid has also recently been considered in first-line therapy for giant cell tumor of bone (GCTB), a primary benign bone tumor with the potential for aggressive local recurrence and development of metastatic disease.

“Zometa is routinely used in diseases like multiple myeloma and other types of metastatic bone cancer (such as breast or lung) that have spread to the bones. It may even decrease the rate of pathologic fractures in these situations,” says Dr. Hornicek. “Denosumab is a human monoclonal antibody and is used for the treatment of osteoporosis, treatment-induced bone loss, metastases to bone and GCTB.”

Keytruda, an immunotherapy medication that is gaining prominence for treating several types of cancer, has also shown recent effectiveness in treating some forms of bone sarcoma.

“Keytruda is a humanized antibody used in cancer immunotherapy that treats melanoma, lung cancer, head and neck cancer, Hodgkin lymphoma, stomach cancer, cervical cancer and certain types of breast cancer,” says Dr. Hornicek, who also serves as Chair, Chief, and Medical Director of Orthopaedics at Jackson Health System. “This drug has shown encouraging activity in patients with undifferentiated pleomorphic sarcoma.”

Finally, an experimental drug being studied in pre-clinical models, known as CADD522, has reduced tumor volumes and improved survival rates for primary bone cancer.

Rotationplasty: A procedure to help patients with knee tumors

While it’s not a new treatment, rotationplasty is a surgical procedure for children or teenagers who have knee tumors, a type of osteosarcoma. In patients who require the knee and surrounding part of the leg to be amputated to remove the cancer, rotationplasty may offer some advantages over a standard lower extremity amputation.

What’s involved? The surgeon removes the knee and the surrounding leg, rotating the lower portion 180 degrees so the foot faces backward, and then reattaching the shortened lower leg to the remaining thigh. The ankle now serves as the knee joint, and a prosthetic completes the leg. This procedure provides greater mobility to the patient compared to alternative methods.

In a 2008 article on rotationplasty, Dr. Hornicek wrote, “This procedure enables patients to avoid phantom pain, limb length discrepancy or loosening of an endoprosthesis, and good functional outcome has been reported. However, rotationplasty is only rarely indicated, and the surgical complications or risk factors for failure of the procedure that might influence choices of treatment or patient counseling have not been well described.”

For patients who do lose a limb due to bone cancer treatment, 3D printing offers hope.

Improvements in 3D printing technology now allow patients to receive custom limb replacements specifically designed and produced to fit them well.

“After removing bones containing tumors, the reconstruction process can incorporate synthetic replacements prepared by 3D printing using titanium,” says Dr. Hornicek. “They are used as custom implants in multiple anatomic locations.”

Today’s bone cancer patients have many treatment options that aim to enhance a person’s quality of life. Advancements have improved survival rates, and technology has increased the standards of care.

Wyatt Myers is a contributing writer for UHealth news service.

Tags: bone cancer, bone health, cancer care in Miami, Dr. Francis Hornicek, ortho-oncology, Sylvester Comprehensive Cancer Center