Chemotherapy for Salivary Gland Cancer

Quit smoking before salivary gland 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 you can) 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 salivary gland cancers?

Chemotherapy (chemo) is treatment with anti-cancer drugs that are given into a vein or by mouth. These drugs enter the bloodstream and reach almost all areas of the body. Chemo is not often used to treat salivary gland cancers because, in general, it does not work well in these cancers .

For people with salivary gland cancers, chemo is most often used:

• When the cancer has spread (metastasized) to distant organs
• If the cancer could not be controlled by surgery and radiation therapy

Chemo sometimes shrinks the tumors, but it’s not likely to cure this type of cancer.

Chemoradiation is chemotherapy given at the same time as radiation. It is used to treat salivary gland cancer cells that are too small to be seen by the naked eye and have features that put them at high risk for coming back after surgery or salivary gland cancers that cannot be removed by surgery. There are not many studies to support chemoradiation in these instances for salivary gland cancer, so it is not routinely done. Clinical trials are being done to look more at using chemoradiation to treat unresectable (cannot be removed by surgery) salivary gland cancers . 

How is chemotherapy given?

Chemo drugs for salivary gland 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 stronger 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 different kinds of CVCs. The most common types are the port and the PICC line.

Chemotherapy is given in cycles: the drug or a combination of drugs is 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.

Chemo drugs used to treat salivary gland cancer

Some of the chemo drugs used to treat salivary gland cancers include:

• Cisplatin
• Mitoxantrone
• Doxorubicin (Adriamycin)
• Epirubicin (Ellence)
• Cyclophosphamide (Cytoxan)
• Paclitaxel (Taxol)
• Docetaxel (Taxotere)
• Vinorelbine (Navelbine)
• Methotrexate

These drugs may be used alone, but are more often given in combinations of 2 or more drugs. Because salivary gland cancers are not common and because there are different types of salivary gland cancers, no large studies have been done to prove one chemo plan is better than the others. The best way to use chemotherapy to treat salivary gland cancer is not clear. New chemo drugs and combinations of drugs are being studied in clinical trials.

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, like those in the bone marrow (where new blood cells are made), the lining of the mouth and intestines, and the hair follicles, also divide quickly. These cells are also likely to be affected by chemo, which can lead to side effects.

The side effects of chemo depend on the type and dose of drugs given and the length of time they are used. Common side effects include:

• Hair loss
• Mouth sores
• Loss of appetite
• Nausea and vomiting
• Diarrhea or constipation

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

• Increased chance of infections (from having too few white blood cells)
• Easy bruising or bleeding (from having too few blood platelets)
• Fatigue (from having too few red blood cells)

Along with the risks above, some side effects are seen more often with certain chemo drugs.  For example:

• Cisplatin and paclitaxel can cause nerve damage (neuropathy). This can sometimes lead to hearing loss or problems in the hands and feet such as pain, burning or tingling sensations, sensitivity to cold or heat, or weakness. In most cases, this gets better or goes away once treatment stops, but it can last a long time in some people.
• Cisplatin can also hurt the kidneys. To help prevent kidney damage, intravenous (IV) fluid is given before and after each dose. 

You should report any problems you have while getting chemo to your medical team, so that they can be treated right away.

There are often ways to lessen these side effects, and they usually go away over time after treatment ends. Be sure to ask your doctor or nurse what can be done to help reduce side effects, and let them know when you do have side effects so they can be managed . For example, drugs can be given to help prevent or reduce nausea and vomiting. In some cases, the doses of the chemo drugs may need to be lowered or treatment may need to be delayed or stopped to keep the effects from getting worse.