Chemotherapy (chemo) is treatment with anti-cancer drugs that are given into a vein or by mouth. These drugs enter the bloodstream and reach all areas of the body, making this treatment useful for cancers that have spread beyond the head and neck. Some chemo drugs may also make cancer cells more vulnerable to radiation.
Chemotherapy is not often used to treat salivary gland cancers. Some doctors may use it along with radiation therapy to try to make the radiation more effective, but it's not yet clear how helpful this is. More often, chemo is used in patients whose cancer has spread (metastasized) to distant organs and in patients whose cancers could not be controlled by surgery and radiation therapy. Chemotherapy sometimes shrinks tumors when used in these patients, but it is not likely to cure this type of cancer.
Doctors give chemo in cycles, with each period of treatment followed by a rest period to allow the body time to recover. Chemotherapy cycles generally last about 3 to 4 weeks. Chemotherapy is often not recommended for patients in poor health, but advanced age by itself is not a barrier to getting chemo.
Some of the chemotherapy drugs used to treat salivary gland cancers include:
- Cisplatin
- Carboplatin
- Doxorubicin (Adriamycin®)
- 5-fluorouracil (5-FU)
- Cyclophosphamide (Cytoxan®)
- Paclitaxel (Taxol®)
- Vinorelbine (Navelbine®)
- Methotrexate
These drugs may be used alone, but are more often used in combinations of 2 or more drugs. Because salivary gland cancers are so uncommon, there are no large studies proving one regimen is better than the others. The situation is also complicated by the fact that there are different types of salivary gland cancers. New chemotherapy drugs and combinations of drugs are currently being studied.
Possible side effects of chemotherapy
Chemotherapy drugs work by attacking 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, 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 chemotherapy depend on the type and dose of drugs given and the length of time they are taken. These side effects can include:
- Hair loss
- Mouth sores
- Loss of appetite
- Nausea and vomiting
- Increased chance of infections (due to low white blood cell counts)
- Easy bruising or bleeding (due to low blood platelet counts)
- Fatigue (due to low red blood cell counts)
These side effects are usually short-term and go away after treatment is finished. There are often ways to lessen these side effects. For example, there are drugs that can be given to help prevent or reduce nausea and vomiting. Be sure to ask your doctor or nurse about medicines to help reduce side effects, and let him or her know when you do have side effects so they can be managed effectively.
Some drugs can have other side effects. For example, cisplatin and carboplatin can damage nerves (called neuropathy). This can sometimes lead to hearing loss or symptoms in the hands and feet such as pain, burning or tingling sensations, sensitivity to cold or heat, or weakness. In most cases this improves or goes away once treatment is stopped, but it may be long lasting in some people. You should report this, as well as any other side effects or changes you notice while getting chemotherapy, to your medical team so that they can be treated promptly. In some cases, the doses of the chemotherapy drugs may need to be reduced or treatment may need to be delayed or stopped to prevent the effects from getting worse.
For more information on chemotherapy, see our document called Understanding Chemotherapy: A Guide for Patients and Families.
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