Chemotherapy for Oral Cavity and Oropharyngeal Cancer

Quit smoking before oral cavity and oropharyngeal cancer treatment

If you smoke, you should quit. Smoking during chemotherapy treatment can cause more side effects and can cause the chemo drugs to not work as well. It can give you a higher chance of getting an infection and is linked to worse outcomes. Smoking after treatment can 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 oral cavity and oropharyngeal cancers?

Chemotherapy (chemo) is treatment with anti-cancer drugs that are injected into a vein or taken by mouth, which allows them to enter the blood and reach most parts of the body. 

Chemo might be used at different times in the treatment process for treatment of oral cavity or oropharyngeal cancers:

• Adjuvant chemotherapy is given after surgery and is sometimes combined with radiation therapy. The goal is to kill cancer cells that might have been left behind at surgery because they were too small to see. This helps lower the chance that the cancer will come back.
• Neoadjuvant or induction chemotherapy is given before surgery. Sometimes the chemo is given first followed by radiation. Other times, it is given at the same time as radiation. The goal is to shrink some larger cancers to make surgery easier and remove less tissue. This can lead to fewer serious side effects and problems from surgery.
• For advanced cancer, chemo (with or without radiation therapy) can be used to treat cancers that are too large or have spread too far to be removed by surgery. The goal is to slow the growth of the cancer for as long as possible and to help relieve any symptoms the cancer is causing.

Chemoradiation

Chemoradiation is chemotherapy given at the same time as radiation. It has been shown to shrink oral cavity and oropharyngeal tumors more than either treatment alone and is helpful for people whose cancers are not widespread, but are too advanced for surgery. 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 chemo, the targeted drug cetuximab might be used with radiation instead. See below for more chemo drugs that might be used with radiation.

How is chemotherapy given?

Chemo drugs for oral cavity or oropharyngeal 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 vein 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 different 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 neoadjuvant chemo is often given for a total of 3 to 6 months, depending on the drugs used. The length of treatment depends on how well it is working and what side effects you might have.

Chemo drugs used to treat oral cavity or oropharyngeal cancer

The chemo drugs used most often for cancers of the oral cavity and oropharynx that can be given with or without radiation include:

• Cisplatin
• Carboplatin
• 5-fluorouracil (5-FU)
• Paclitaxel (Taxol)
• Docetaxel (Taxotere)
• Hydroxyurea

Other drugs that are used less often include:

• Methotrexate
• Capecitabine

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. A commonly used combination is carboplatin and 5-FU. This combination works better than either drug alone in shrinking cancers of the oral cavity and oropharynx. Another combination often used is cisplatin, 5-FU, plus docetaxel. In certain cases, chemo might be given along with a targeted drug or immunotherapy.

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 and are affected. This can lead to side effects.

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

• Hair loss
• Mouth sores
• Loss of appetite or weight loss
• Nausea and vomiting
• Diarrhea
• Nail changes
• Skin changes

Chemo can 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. This often improves once treatment is stopped, but for some people it can last a long time. Cisplatin can also cause kidney damage. To help prevent this, intravenous (IV) fluid is given before and after each dose.

Most side effects tend to get better over time once treatment is stopped. Some, such as neuropathy can last a long time or even be permanent. If your doctor plans treatment with chemo be sure to discuss the drugs that will be used and the possible side effects. Once chemo is started, tell your health care team if you notice any changes or have any side effects. There are ways to prevent or treat many of the side effects of chemo. 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 help keep the problem from getting worse.