Systemic chemotherapy (chemo) uses anticancer 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 cancer that has spread or metastasized to organs beyond the nasal cavity and paranasal sinuses. Chemo may also be given to shrink the tumor before surgery (called neoadjuvant), or it may be given after surgery to help prevent the cancer from coming back later (called adjuvant). When chemotherapy is given before or after surgery, it is often combined with radiation therapy (chemoradiation). Chemo for nasal cavity and paranasal sinus cancer may include a combination of several anticancer drugs. Because nasal and paranasal sinus cancers are so rare, there aren't many studies to decide the best way to treat them. Often, doctors treat them with the same drugs that are used for other, more common, cancers of the head and neck.

The most common types of nasal cavity and paranasal sinus cancers, squamous cell carcinoma, adenocarcinoma, and adenoid cystic carcinoma, can be grouped together as carcinomas. Some of the chemo drugs commonly used to treat carcinomas include carboplatin, cisplatin, 5-fluorouracil (5-FU), docetaxel (Taxotere), and paclitaxel (Taxol). Cisplatin (sometimes combined with 5-FU) is the drug most often given with radiation. Recent studies have shown that giving docetaxel with these 2 drugs may work even better. Other drugs that can be helpful to treat these cancers include bleomycin, cyclophosphamide, vinblastine, and methotrexate. Chemo drugs may be used alone, but more often they are used in combination with one another. New chemotherapy drugs and combination treatments are currently being studied.

Different chemo drugs are used for sarcoma and melanoma. Information about chemotherapy for sarcomas may be found in our document, Sarcoma -- Adult Soft Tissue Cancer. Drug therapy for melanoma is covered in our document, Melanoma Skin Cancer.

Chemotherapy drugs kill cancer cells but can also damage some normal cells, leading to some side effects. The side effects seen depend on the type of drugs given, the amount taken, and the length of treatment. Common temporary side effects of chemo include:

• nausea and vomiting
• loss of appetite
• loss of hair
• hand and foot rashes
• mouth sores
• low blood counts

Chemo can damage the blood-producing cells of the bone marrow, so patients may have low blood cell counts. This can result in an increased chance of infection (due to a shortage of white blood cells), bleeding or bruising after minor cuts or injuries (due to a shortage of blood platelets), and fatigue (due to low red blood cell counts). If the blood counts get too low, treatment may need to be delayed for a time so that they return to a safe level.

Most side effects disappear once treatment is stopped. Hair will grow back after treatment ends, though it may look different. There are remedies for many of the temporary side effects of chemotherapy. For example, there are very good drugs to prevent or reduce nausea and vomiting.

Some side effects can continue long after treatment is stopped. For example, cisplatin can cause nerve damage leading to numbness of the hands and feet (this is called neuropathy). It can also cause hearing loss. These symptoms usually improve after the drug is stopped, but may not go away completely. It is important to talk with your doctor about the chemotherapy drugs that will be used and their possible side effects.

Many doctors are treating more advanced nasal and paranasal cancers with a combination of treatments that often includes chemotherapy. Often this is given at the same time as radiation therapy. Cisplatin and carboplatin are chemotherapy drugs that are often given with radiation. Some doctors give the drugs directly into arteries leading to the tumor. This concentrates the chemotherapy into the area that needs it to try to reduce side effects.

Targeted therapy

A drug called cetuximab (Erbitux^®) can also be helpful in treating these cancers. It is considered a type of targeted therapy because it blocks the receptor for a certain hormone-like substance. This receptor is found in high amounts on the surface of the cells of head and neck cancers. Cetuximab belongs to a class of drugs called EGFR inhibitors. It blocks the activity of a certain hormone-like substance called epidermal growth factor that signals cells to grow and divide. It doesn't have the same side effects as regular chemo drugs. The most common side effect is a rash similar to acne. This rash can be severe, and can cause patients to stop treatment. Also, this drug is given as an infusion into a vein (IV) and sometimes allergic reactions occur during the infusion. Other side effects include diarrhea, headaches, and feeling itchy. Cetuximab is commonly given with radiation to treat cancers that cannot be removed with surgery. It can also be given alone or even with standard chemo drugs to help them work better.

Last Medical Review: 08/13/2009
Last Revised: 08/13/2009