Drug therapies for head and neck cancers

Chemotherapy

Chemotherapy is the use of drugs to kill or slow the growth of cancer cells. The aim is to destroy cancer cells while causing the least possible damage to healthy cells. You will usually receive chemotherapy by injection into a vein (intravenously), although it is occasionally given as tablets. How often you have chemotherapy sessions will depend on the treatment plan.

Chemotherapy may be given for a range of reasons:

• in combination with radiation therapy (chemoradiation), to increase the effects of radiation
• before surgery or radiation therapy (neoadjuvant chemotherapy), to shrink a tumour
• after surgery (adjuvant chemotherapy), given along with radiation therapy, to help reduce the risk of the cancer returning
• as palliative treatment to help relieve symptoms.

Side effects of chemotherapy

Chemotherapy can affect the healthy cells in the body and cause side effects. Everyone reacts differently to chemotherapy, and effects will vary according to the drugs you are given. Some people may have few side effects, while others have many. Not all chemotherapy causes nausea. Your medical oncologist or nurse will discuss likely side effects, including how these can be prevented or controlled with medicine.

Common side effects can include tiredness and fatigue; nausea and/or vomiting; tingling or numbness in fingers and/or toes (peripheral neuropathy); changes in appetite and loss of taste; diarrhoea or constipation; hair loss; low red blood cell count (anaemia); hearing loss; ringing in the ears (tinnitus); lower levels of white blood cells, which may increase the risk of infection; and mouth sores.

Keep a record of the names and doses of your chemotherapy drugs handy in case you need to go to the hospital emergency department.

Other drug therapies

Some head and neck cancers – most commonly those that have come back – may be treated with other drug therapies that reach cancer cells throughout the body (systemic therapies). These may include targeted therapy and immunotherapy, which work in different ways to chemotherapy. They can be combined with other treatments such as chemotherapy or radiation therapy.

Targeted therapy

Targeted therapy targets specific features of cancer cells to stop the cancer growing and spreading. Tests may be done on a biopsy sample to look for these specific features. Each targeted therapy drug works on a particular feature, and the drug will only be given if the cancer cells have that feature. For some head and neck cancers, targeted therapy drugs are occasionally used when people cannot take the standard chemotherapy drug or the cancer is advanced.

Immunotherapy

Immunotherapy uses the body’s own immune system to fight cancer. The main type of immunotherapy drugs used in Australia are called checkpoint inhibitors. They help the immune system to recognise and attack cancer cells. Checkpoint inhibitors may be used to treat some types of advanced head and neck cancer.

New targeted therapy and immunotherapy drugs are often studied in clinical trials. Ask your doctor if this is an option for you.