Chemotherapy for Nasopharyngeal Cancer

Since these cancers are not common in the US and are located near many critical structures in your head and neck, it’s very important to go to a cancer center that has experience treating these cancers. This will help coordinate care between cancer specialists to make a complete treatment plan and might help people live longer. 

Quit smoking before nasopharyngeal cancer treatment

If you smoke, you should quit. Smoking during chemotherapy treatment can cause more side effects and can cause . It can give you a higher chance of getting an infection and is linked to worse outcomes. Smoking after treatment might also increase the risk of the cancer coming back and of getting another new cancer. Quitting smoking (before treatment starts, if possible) is the best way to improve your chances of survival. It is never too late to quit. For help, see How To Quit Using Tobacco.

How is chemotherapy used to treat nasopharyngeal cancers?

Chemotherapy (chemo) is the use of anti-cancer drugs to treat cancer. These drugs are most often given into a vein (IV) or by mouth which allows them to enter the bloodstream and reach most parts of the body.

Chemo may be used in different ways to treat nasopharyngeal cancer (NPC):

• Along with radiation therapy (chemoradiation) as the main treatment for more advanced stages of NPC.
• As the first treatment before chemoradiation. This is called induction chemo. This method can help some people with NPC live longer.
• After radiation (or after chemoradiation). This is known as adjuvant chemotherapy.
• To help with symptoms, such as pain, bleeding, or trouble swallowing, in people with advanced NPC. It may be used alone or along with radiation.
• To treat cancer that has come back after initial treatment (recurrence).

How is chemotherapy given?

Chemo drugs for nasopharyngeal cancer are usually given by mouth or into a vein (IV) as an infusion over a certain period of time. This can be done in a doctor’s office, infusion center, or in a hospital setting.

Often, a slightly larger and sturdier IV is required in the system for chemo. These IVs are known as central venous catheters (CVCs), central venous access devices (CVADs), or central lines. They are used to put medicines, blood products, nutrients, or fluids right into your blood. They can also be used to take blood for tests. There are many kinds of CVCs. The most common types are the port and the PICC line.

Chemotherapy is given in cycles: one drug or a combination of drugs given on a set schedule, followed by a rest period. Common schedules of chemo cycles can be once a week, once every 3 weeks, or once every 4 weeks. The schedule depends on the drugs used. The chemo schedule repeats to start the next cycle.

Adjuvant or induction chemo is often given for 2 or 3 months, depending on the drugs used. 

Chemo might not be a good option for people in poor health, but advanced age by itself should not keep anyone from getting chemo.

Common chemo drugs used to treat NPC

Cisplatin is the chemo drug used most often to treat NPC. It can be used alone or as part of chemoradiation (see below). Or it may be combined with another drug, 5-fluorouracil (5-FU) or gemcitabine, to be given after chemoradiation or as induction chemotherapy. Sometimes, carboplatin might be used if cisplatin is not a good choice.  

Some other drugs that might also be helpful in treating NPC with or without radiation include:

• Carboplatin (Paraplatin)
• Epirubicin (Ellence)
• Paclitaxel (Taxol)
• Docetaxel (Taxotere)
• Gemcitabine (Gemzar)
• Capecitabine (Xeloda)
• Methotrexate

A chemo drug may be used alone or combined with other drugs. Combining drugs can often shrink tumors better but tend to cause more side effects.

Chemoradiation

Chemoradiation is chemotherapy given at the same time as radiation. It has been shown to shrink nasopharyngeal tumors more than either treatment alone and is helpful for people whose cancers are locally advanced. But this combined approach can be hard to tolerate, especially for people in poor health.

A preferred schedule is to give a dose of cisplatin every 3 weeks (for a total of 2 to 3 doses) during radiation. For people who cannot tolerate cisplatin, carboplatin might be used with radiation instead.

Possible side effects of chemotherapy

Chemo drugs attack cells that are dividing quickly, which is why they work against cancer cells. But other cells in the body such as those in the bone marrow, the lining of the mouth and intestines, and the hair follicles also divide quickly. This can lead to certain side effects.

The side effects of chemo depend on the type and dose of drugs given and how long they are taken. Common short-term side effects can include:

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

Chemo can also affect the blood-producing cells of the bone marrow, which can lead to:

• Increased chance of infections (from low white blood cell counts)
• Easy bruising or bleeding (from low blood platelet counts)
• Fatigue (from low red blood cell counts)

Along with the risks above, some side effects are seen more often with certain chemo drugs. For example, 5-FU often causes diarrhea. This might need to be treated with drugs like loperamide. Cisplatin, docetaxel, and paclitaxel can cause nerve damage (called neuropathy). This can lead to numbness and tingling in the hands and feet or hearing loss. This often improves once treatment is stopped, but for some people it can last a long time. Cisplatin can also damage kidneys . To help prevent this, intravenous (IV) fluid is given before and after each dose.

These side effects usually go away over time after treatment ends. Once chemo starts, let your health care team know if you have side effects, so they can be treated. There are ways to prevent or treat many of them . For example, many drugs are available to help prevent or treat nausea and vomiting. In some cases, the doses of the chemo drugs may need to be reduced or treatment may need to be delayed or stopped to keep side effects from getting worse.