Immunotherapy for Oral Cavity and Oropharyngeal Cancer

Immunotherapy can be used to treat oral cavity and oropharyngeal cancers. Immunotherapy is the use of medicines to help boost a person’s own immune system to find and destroy cancer cells more effectively. It typically works on specific proteins involved in the immune system to enhance the immune response. It has different (sometimes less severe) side effects than chemotherapy.

Some immunotherapy drugs, for example, monoclonal antibodies, work in more than one way to control cancer cells and may also be considered targeted drug therapy because they block a specific protein on the cancer cell to keep it from growing.

Immune checkpoint inhibitors for oral cavity and oropharyngeal cancers

An important part of the immune system is its ability to keep itself from attacking normal cells in the body. To do this, it uses “checkpoints,”  proteins on immune cells that need to be turned 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 oral cavity or oropharyngeal cancer.

PD-1 inhibitors

Pembrolizumab (Keytruda) and nivolumab (Opdivo) are drugs that 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.

These drugs can be used after chemotherapy stops working in people with oral cavity or oropharyngeal cancer that has returned after treatment (recurrent) or that has spread to other parts of the body (metastatic).  Nivolumab is given as an intravenous (IV) infusion every 2 or 4 weeks. Pembrolizumab is given as an IV infusion every 3 or 6 weeks.

Pembrolizumab, alone or with chemotherapy, is also an option as the first treatment in some people whose cancer has recurred, is metastatic, or cannot be removed with surgery. It is given as an IV infusion every 3 or 6 weeks.

Possible side effects of PD-1 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 cause 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 removing one of the safeguards of the body’s immune system. Sometimes the immune system starts attacking other 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 might need to stop treatment and take high doses of corticosteroids to suppress your immune system.