Immunotherapy for Laryngeal and Hypopharyngeal Cancers

Immunotherapy is the use of medicines that help a person’s own immune system find and destroy cancer cells more effectively.

Immune checkpoint inhibitors

An important part of your immune system is its ability to keep itself from attacking normal cells. To do this, it turns “checkpoints” or proteins on immune cells on (or off) to start an immune response. Cancer cells sometimes use these checkpoints to avoid being attacked by the immune system.

Drugs that target these checkpoints (called checkpoint inhibitors) can be used to treat some people with laryngeal and hypopharyngeal cancer.

PD-1 inhibitors

Pembrolizumab (Keytruda) and nivolumab (Opdivo) target PD-1, a protein on T cells in the immune system. PD-1 normally helps keep T cells from attacking other cells. By blocking PD-1, these drugs boost the immune response against cancer cells. This can shrink some tumors or slow their growth.

In people with laryngeal or hypopharyngeal cancer that has returned after treatment or that has spread to other parts of the body, pembrolizumab can be used first, either alone or in combination with chemotherapy, unless the person is not a candidate for immunotherapy. Nivolumab and pembrolizumab can also be used by themselves if chemotherapy stops working.

These drugs are given as an intravenous (IV) infusion, typically every 3, 4, or 6 weeks.

Possible side effects of checkpoint inhibitors

Side effects of these drugs can include fatigue, cough, nausea, diarrhea, skin rash, loss of appetite, constipation, joint pain, and itching.

Other, more serious side effects occur less often:

Infusion reactions: Some people might have an infusion reaction while getting these drugs. This is like an allergic reaction, and can include fever, chills, flushing of the face, rash, itchy skin, feeling dizzy, wheezing, and trouble breathing. It’s important to tell your doctor or nurse right away if you have any of these symptoms while getting these drugs.

Autoimmune reactions: These drugs work by basically removing one of the safeguards on the body’s immune system. Sometimes the immune system starts attacking other normal parts of the body, which can cause serious or even life-threatening problems in the lungs, intestines, liver, hormone-making glands, kidneys, nerves, skin, or other organs.

It’s very important to report any new side effects during or after treatment with any of these drugs to your health care team promptly. If serious side effects do occur, you may need to stop treatment and take high doses of corticosteroids to suppress your immune system.