Targeted cancer drugs for bone cancer
Targeted drugs work by targeting the differences in cancer cells that help them to grow and survive. You might have them as part of your treatment for bone cancer.
What are targeted cancer drugs?
Cancer cells have changes in their 
() that make them different from normal cells. These changes mean that they behave differently. Cancer cells can grow faster than normal cells and they die less easily too. Cancer cells also sometimes spread.
Targeted cancer drugs work by ‘targeting’ those differences that a cancer cell has.
Targeted drugs work in different ways. For example, they can:
- stop cancer cells from dividing and growing
- seek out cancer cells and kill them
- encourage the
immune system to attack cancer cells - stop cancers from growing blood vessels
- help carry other treatments such as chemotherapy, directly to the cancer cells
You might hear some targeted drugs called biological therapies.
When might you have targeted cancer drugs for bone cancer
You might have a type of targeted cancer drug as a treatment for bone cancer. This depends on:
- the type of bone cancer you have
- how far the cancer has grown - this is the
stage - any treatments you've already had
- your general health and well being
You might have a targeted cancer drug on its own. Or you have it together with .
The targeted cancer drug might be a , or part of a .
Some primary bone cancers come back and there are no standard treatment options left. Your doctor might suggest a new promising medicine that has not yet been approved as a standard treatment. Your doctor applies to use this medicine on an individual basis. This is called compassionate use.
Not all medicines are available in every treatment centre. Your doctor will tell you if you might be able to have one of these medicines.
Types of targeted cancer drugs
There are different types of targeted cancer drugs and they work in different ways. For bone cancer you might have a:
- tyrosine kinase inhibitors or TKIs
- targeted cancer drug that helps the immune system
- monoclonal antibody or mAb
The type of targeted cancer drug you have depends on your type of bone cancer.
Tyrosine kinase inhibitors
Tyrosine kinase inhibitors (TKIs) are a type of cancer growth inhibitor (blocker).
Tyrosine kinases are proteins that cells use to signal to each other to grow. They act as chemical messengers. There are a number of different tyrosine kinases and blocking them stops the cancer cells growing.
Some of the TKI’s include:
- imatinib – you might have this for chordoma
- sunitinib- you might have this for chordoma if imatinib is no longer working or is causing side effects
- pazopanib – you might have this for chondrosarcoma or osteosarcoma
- cabozantinib - you might have this for osteosarcoma or Ewing sarcoma
- regorafenib - you might have this for osteosarcoma or Ewing sarcoma
- lenvatinib - you might have this for osteosarcoma
Target cancer drug that helps the immune system
Mifamurtide is a type of targeted cancer drug that boosts the immune system to kill cancer cells. It makes the immune system produce certain types of white blood cells called monocytes and macrophages.
Children and young adults might have mifamurtide alongside chemotherapy after you have had surgery. It is for those:
- aged between 2 and 30
- with
high grade osteosarcoma that hasn’t spread
It's not a common treatment for people with bone cancer.
Monoclonal antibody (mAb)
Monoclonal antibodies work in different ways to kill cancer cells or stop them from growing. They are often classed as a targeted cancer drug or immunotherapy, but they can work in both ways.
In bone cancer you might have a type of a monoclonal antibody called denosumab. Denosumab works by targeting a protein called RANKL which controls the activity of osteoclasts. Osteoclasts are special bone cells involved in breaking down old bone. This stops bone cells being broken down and strengthens the bone.
You might have denosumab if you have a type of primary bone cancer called giant cell tumour of the bone. You might have it if you are unable to have surgery and your cancer has spread to different parts of the body (metastases).
Having targeted drugs
Depending on the type of targeted treatment you are having will depend on how you have your medicine. You might:
- take it as a tablet or capsule
- have it as a drip into the bloodstream (intravenously)
- have an injection just below the skin - this is known as a subcutaneous injection
You have mifamurtide through a tube into your bloodstream. You take the tyrosine kinase inhibitors as a tablet or capsule. You have detumomab as a subcutaneous injection.
Into your bloodstream
You might have treatment through a long plastic tube that goes into a large vein in your chest. The tube stays in place throughout the course of treatment. This can be a:
- central line
- PICC line
- portacath
If you don't have a central line
You might have treatment through a thin short tube (a cannula) that goes into a vein in your arm. You have a new cannula each time you have treatment.
Taking your tablets or capsules
You must take tablets and capsules according to the instructions your doctor or pharmacist gives you.
Whether you have a full or empty stomach can affect how much of a drug gets into your bloodstream.
You should take the right dose, not more or less.
Talk to your healthcare team before you stop taking a cancer drug, or if you have missed a dose.
Injection under your skin
You have denosumab as an injection under the skin (subcutaneous injection). Usually into your tummy (abdomen), thigh or top of your arm. You might have stinging or a dull ache for a short time after this type of injection. The skin in the area may go red and itchy for a while.
Side effects
Targeted cancer drugs can cause different side effects. Some of these can be serious. Your doctor or nurse will talk to you about this. Always tell them about any side effects you have and follow the advice they give you.
Choose a drug on our A to Z list to read about side effects.
When you go home
Treatment with targeted cancer drugs and chemotherapy can be difficult to cope with. Your nurse will give you numbers to call if you have any problems at home.
Tell your doctor or nurse about any problems or side effects you have.
You can call the Cancer Research UK information nurses for information and support on freephone 0808 800 4040. The lines are open Monday to Friday, 9am to 5pm.
