Cancer in Bones

While bone metastases can be difficult to live with, there are many treatment options available for alleviating pain and treating the cancer itself.

These treatments include:

• Bisphosphonates: When breast cancer has spread to the bone, bisphosphonates are given intravenously to slow abnormal bone destruction and formation, to ease bone metastisis pain, to reduce the risk of fractures and to prevent new lesions. Bisphosphonates are not chemotherapy but must be administered intravenously so they are properly absorbed. Oral bisphosphonates may cause gastrointestinal side effects and are not effective for patients with bone metastases. IV bisphosphonates and conventional treatments (chemotherapy and radiation) complement each other and are often used in combination. Aredia® (pamidronate) is administered over two to four hours to reduce the risk of fractures and other bone complications. There are two kinds of bone mets, osteolytic and osteoblastic - most women with bone mets have osteolytic lesions and this is what Aredia targets. Zometa® (zoledronic acid) is the most widely used bisphosphonate to treat bone metastases. It is administered over 15 minutes to slow abnormal bone destruction and formation, to ease bone metastisis pain and to reduce the risk of fractures. It has been proven effective for women who have osteolytic or osteoblastic bone metastases. It is also used to lower the amount of calcium in patients with hypercalcemia (too much calcium in the blood) caused by tumors.

• Chemotherapy: Various types of chemotherapy are given to treat bone metastases as well as bone pain. Choices in chemotherapy drugs are usually determined by the drugs the patient has previously been given (the doctor would want to try something new), and the potential for side effects (such as low white blood cell count). In addition, an important factor can also be the administration schedule required--if you have to choose between a treatment that would require a visit to your oncologist once a week versus once every three weeks, you might prefer going to the doctor less often (all other considerations being equal).

• Radiation therapy: Many women receive adjuvant radiation therapy at the site of their bone metastases to relieve pain. The relief generated by radiation tends not to last as long, but can be effective for some people.

• Hormone therapy: This is a treatment option that is offered to women whose cancer is estrogen dependent. While it may not seem the most aggressive approach, hormone therapy is a very effective treatment for bone metastases. Many women who are ER+ and have bone mets are given an aromatase inhibitor, such as anastrozole, letrozole, or exemestane (brand name: Aromasin®). An older alternative is tamoxifen, which is another kind of hormone therapy. Tamoxifen blocks estrogen after it is formed and aromatase inhibitors prevent its production. All these can stabilize and even fight the disease in the bone.

• Metastron®: This treatment is a radiopharmaceutical, which cannot be taken while on chemotherapy. Metastron targets osteoblastic lesions, and can be taken in addition to pamidronate. Metastron is administered by certified nuclear medicine technologists in the nuclear medicine department at your treatment facility. It is injected into a vein in your arm -- it is possible for one injection to alleviate bone pain for weeks or months. For the first few days after your injection, you will have to take some precautions due to the level of radioactive drug in your system. After this precautionary time period, you can resume your normal activities without concern.

• Quadramet®: This treatment is also a radiopharmaceutical, which is administered by a certified nuclear medicine technologist. Quadramet alleviates bone pain, and targets osteoblastic lesions. An injection of Quadramet can relieve bone pain for weeks or months; it requires the same treatment administration and precautions as other radiopharmaceutical drugs for bone metastases.