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Medicines can be used to prevent problems with bones weakened by cancer metastasis in people who have a cancer of unknown primary (CUP). Another drug is very helpful for some patients with neuroendocrine tumors. If the tumor releases hormones into the bloodstream, this drug can stop that. It can also stop tumors from growing or (rarely) shrink them.

Using bisphosphonates for cancers of unknown primary (CUP)

Bisphosphonates are drugs that are used to help strengthen bones weakened by metastatic cancer. These drugs can reduce the risk of fractures. and include pamidronate (Aredia), zoledronic acid (Zometa), and clodronate (Bonefos). They are given in a vein (intravenously; IV) once a month.

Bisphosphonates can have side effects, including flu-like symptoms and bone pain. They can also cause kidney problems, so people with kidney problems cannot use them.

A rare but distressing side effect of intravenous bisphosphonates is damage to the jawbone called osteonecrosis of the jaw (ONJ). It can be triggered by having a tooth removed while getting treated with the bisphosphonate. ONJ often appears as an open sore in the jaw that won’t heal. It can lead to loss of teeth or infections of the jaw bone.

Doctors don’t know why this happens or how to treat it, other than to stop the bisphosphonate drug. Good oral hygiene by flossing, brushing, making sure that dentures fit properly, and having regular dental check-ups may help prevent ONJ. Most doctors recommend that patients have a dental check-up and have any tooth or jaw problems treated before they start taking a bisphosphonate.

Using denosumab for cancers of unknown primary (CUP)

Like bisphosphonates, denosumab (Prolia^?, Xgeva) can be used to strengthen and reduce the risk of fractures in bones weakened by metastases. This drug is injected under the skin once a month to treat cancer that has spread to the bones.

Side effects include low levels of calcium and phosphate and ONJ. This drug does not cause kidney damage, so it is safe to give to people with kidney problems.

Using somatostatin analogs for cancers of unknown primary (CUP)

This type of drug is very helpful for some patients with well-differentiated neuroendocrine tumors. If the tumor releases hormones into the bloodstream (which is rare in the poorly differentiated  CUP tumors ), this drug can stop the hormone release. It can also cause tumors to stop growing or to shrink. This drug is available as a short-acting version injected 2 to 4 times a day, or as a long-acting injection that needs to be given only once a month. These drugs are most likely to help treat cancers that show up on somatostatin- receptor scintigraphy (OctreoScan).

Using peptide receptor radiation therapy (PRRT) for cancers of unknown primary (CUP)

Lutetium Lu-177 dotatate (Lutathera) is a type of treatment, with two parts: somatostatin analog plus radiation. This drug finds and attaches to cancer cells that have the somatostatin receptor. Once attached, the drug enters the cell, releases radiation, and damages the cancer cell. This form of therapy is most likely to help treat cancers that show up on  somatostatin-receptor scintigraphy (OctreoScan).

More information about treatments for cancers that have spread can be found in Advanced Cancer.