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Chemotherapy (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, so chemo is most likely to be useful for cancers that have spread to other organs.

Chemo is often an important part of treatment for Ewing sarcoma, osteosarcoma, and undifferentiated pleomorphic sarcoma (UPS). But it's used less often for most other types of bone cancers, like giant cell tumors and most types of chordomas and chondrosarcomas. These types aren’t very sensitive to chemo, so other medicines might be tried first instead.

The information here focuses on primary bone cancers (cancers that start in bones) that most often are seen in adults. Information on Osteosarcoma, Ewing Tumors (Ewing sarcomas), and Bone Metastasis is covered separately.

Chemo drugs commonly 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

In most cases, 2 or more drugs are given together.

Side effects of chemo

Chemo kills cancer cells, but it also damages some normal cells, which can lead to side effects. These depend on the type of drugs and doses used, and the length of time they're taken.

Some common short-term side effects can include:

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

Chemo can damage the bone marrow, where new blood cells are made. This can lead to low blood cell counts, which can result in:

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

While you're getting chemo, your doctor will order lab tests to be sure your blood cell counts are at safe levels.

Some side effects are linked to certain drugs. For example:

• Ifosfamide and cyclophosphamide can damage the lining of the bladder and cause bloody urine. The chance of this happening can be lowered by giving a drug called mesna during chemo, along with plenty of fluids.
• Cisplatin may cause nerve damage (called peripheral neuropathy) leading to problems with numbness, tingling, or pain in the hands and feet. Kidney damage can also occur after treatment. Giving lots of fluid before and after the drug is infused can help prevent this. Cisplatin can sometimes affect hearing, especially of high-pitched sounds. Your doctor may have you get a hearing test (called an audiogram) before giving cisplatin.
• Over time, doxorubicin can damage the heart. The risk of this goes up with the total amount of the drug given. Before giving doxorubicin, your doctor may test your heart function to make sure that it's safe to give you this drug.

It’s important to note that many of the serious side effects are uncommon, but they can happen. Talk with your cancer care team so you know what to expect from the chemo you're getting.

The doctors and nurses will watch you closely for side effects. Most side effects tend to go away in time after treatment is over. Still, it's important to tell your cancer care team about any side effects you have so they can be treated. Be sure to discuss any questions you have about side effects with the cancer care team, and tell them about any side effects so that they can be controlled.