Medical Oncology for Head and Neck Cancers

Medical oncology is a type of medicine that focuses on the prevention, diagnosis, and treatment of cancer. Providers who work in medical oncology prescribe “systemic therapy” for cancer. Systemic therapy includes medications that go throughout your body. These medications are different from radiation and surgery, which only target a specific part of your body.

Systemic therapies for head and neck cancer include chemotherapy, targeted therapy, and immunotherapy. These therapies are most often used in advanced head and neck cancers. They may be given before or after surgery. They can also be given before, during, or after radiation therapy.

Your treatment plan may include one medication, or a regimen. A regimen is a group of medications given together to treat your cancer. The regimen tells the provider how much of each medication you should get and how often. Cancers in different areas of the head and neck may be treated with different regimens.

Most regimens include a chemotherapy medication called cisplatin. Other common chemotherapy medications are: carboplatin, 5-FU, docetaxel, and paclitaxel.

Cetuximab is a targeted therapy that is often used in head and neck cancer treatment. This medication targets the EGFR receptor, which is found on many head and neck cancer cells. Larotrectinib is another type of targeted therapy that targets the NTRK genes.

Pembrolizumab and nivolumab are types of immunotherapy medications used to treat head and neck cancers.

In many cases, chemotherapy is given along with radiation. This is called chemoradiation. The chemotherapy is given for two reasons: to kill the cancer cells and to make them more sensitive to radiation (called radiosensitization).

The most common side effects caused by systemic therapy for head & neck cancers are listed below. Remember that the treatment can affect everyone differently, and you may not have these exact side effects. Talk with your care team about what you can expect from your treatment.

• Fatigue is very common with treatment and tends to begin a few weeks into therapy. Fatigue often gets better slowly over the weeks and months following treatment.
• Nausea and vomiting can happen with many systemic therapies. Talk to your care team so they can prescribe medications to help you control nausea and vomiting.
• Peripheral neuropathy is a side effect that is caused by damage to the nerves. It causes a tingling or numbness in the hands and/or feet. Let your care team know if this happens, as they may need to change the dose of your medication.
• Your hair may become thin, brittle, or fall out. This often starts a few weeks after your first treatment.
• Your appetite may decrease and the taste of things may change. People often report a metallic taste in their mouth or they may not like foods they used to. A dietitian can help you with these changes in the hopes of keeping up your weight during treatment. Taste changes often get better, but it can take up to a year for some people.
• Chemotherapy can damage blood cells, leading to low levels of white blood cells, red blood cells, and platelets.
• Targeted therapies have different side effects, which can include skin and nail changes and changes to your hair.
• Immunotherapy medications also have different side effects due to their effect on your immune system. Common side effects are skin reactions, diarrhea, and flu-like symptoms. Your care team will tell you which side effects need to be reported right away when being treated with immunotherapy.

Many of these side effects will get better in the weeks and months following treatment, but some can last longer. Talk with your care team about any side effects you may be having.