Immunotherapy for Laryngeal and Hypopharyngeal Cancers

Immunotherapy is the use of medicines that help a person’s own immune system find and destroy cancer cells more effectively.

Immune checkpoint inhibitors

An important part of your immune system is its ability to keep itself from attacking normal cells. To do this, it turns “checkpoints” or proteins on immune cells 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 laryngeal and hypopharyngeal cancer.

PD-1 inhibitors

Pembrolizumab (Keytruda) and nivolumab (Opdivo) 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.

In people with laryngeal or hypopharyngeal cancer that has returned after treatment or that has spread to other parts of the body, pembrolizumab can be used first, either alone or in combination with chemotherapy, unless the person is not a candidate for immunotherapy. Nivolumab and pembrolizumab can also be used by themselves if chemotherapy stops working.

These drugs are given as an intravenous (IV) infusion, typically every 3, 4, or 6 weeks.

Possible side effects of checkpoint 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 include 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 basically removing one of the safeguards on the body’s immune system. Sometimes the immune system starts attacking other normal 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 may need to stop treatment and take high doses of corticosteroids to suppress your immune system.
 

More information about immunotherapy

To learn more about how drugs that work on the immune system are used to treat cancer, see Cancer Immunotherapy.

To learn about some of the side effects listed here and how to manage them, see Managing Cancer-related Side Effects.

The American Cancer Society medical and editorial content team

Our team is made up of doctors and oncology certified nurses with deep knowledge of cancer care as well as journalists, editors, and translators with extensive experience in medical writing.

Burtness B, Harrington KJ, Greil R, et al. Pembrolizumab alone or with chemotherapy versus cetuximab with chemotherapy for recurrent or metastatic squamous cell carcinoma of the head and neck (KEYNOTE-048): a randomised, open-label, phase 3 study [published correction appears in Lancet. 2020 Jan 25;395(10220):272] [published correction appears in Lancet. 2020 Feb 22;395(10224):564]. Lancet. 2019;394(10212):1915-1928.

Leeman JE, Katabi N, Wong, RJ, Lee NY, Romesser PB. Chapter 65 - Cancer of the Head and Neck. In: Niederhuber JE, Armitage JO, Doroshow JH, Kastan MB, Tepper JE, eds. Abeloff’s Clinical Oncology. 6th ed. Philadelphia, Pa: Elsevier; 2020.

Mendenhall WM, Dziegielewski PT, Pfister DG. Chapter 45- Cancer of the Head and Neck. In: DeVita VT, Lawrence TS, Rosenberg SA, eds. DeVita, Hellman, and Rosenberg’s Cancer: Principles and Practice of Oncology. 11th ed. Philadelphia, Pa: Lippincott Williams & Wilkins; 2019. 

National Cancer Institute. Physician Data Query (PDQ). Laryngeal Cancer Treatment. January 23, 2020. Accessed at https://www.cancer.gov/types/head-and-neck/hp/adult/laryngeal-treatment-pdq on September 8, 2020. 

National Cancer Institute. Physician Data Query (PDQ). Laryngeal Cancer Treatment. November 21, 2019. Accessed at https://www.cancer.gov/types/head-and-neck/patient/adult/laryngeal-treatment-pdq on September 8, 2020. 

National Comprehensive Cancer Network (NCCN). NCCN Clinical Practice Guidelines in Oncology: Head and Neck Cancers. V.2.2020 – June 09, 2020. Accessed at www.nccn.org/professionals/physician_gls/pdf/head-and-neck.pdf on September 8, 2020. 

References

Burtness B, Harrington KJ, Greil R, et al. Pembrolizumab alone or with chemotherapy versus cetuximab with chemotherapy for recurrent or metastatic squamous cell carcinoma of the head and neck (KEYNOTE-048): a randomised, open-label, phase 3 study [published correction appears in Lancet. 2020 Jan 25;395(10220):272] [published correction appears in Lancet. 2020 Feb 22;395(10224):564]. Lancet. 2019;394(10212):1915-1928.

Leeman JE, Katabi N, Wong, RJ, Lee NY, Romesser PB. Chapter 65 - Cancer of the Head and Neck. In: Niederhuber JE, Armitage JO, Doroshow JH, Kastan MB, Tepper JE, eds. Abeloff’s Clinical Oncology. 6th ed. Philadelphia, Pa: Elsevier; 2020.

Mendenhall WM, Dziegielewski PT, Pfister DG. Chapter 45- Cancer of the Head and Neck. In: DeVita VT, Lawrence TS, Rosenberg SA, eds. DeVita, Hellman, and Rosenberg’s Cancer: Principles and Practice of Oncology. 11th ed. Philadelphia, Pa: Lippincott Williams & Wilkins; 2019. 

National Cancer Institute. Physician Data Query (PDQ). Laryngeal Cancer Treatment. January 23, 2020. Accessed at https://www.cancer.gov/types/head-and-neck/hp/adult/laryngeal-treatment-pdq on September 8, 2020. 

National Cancer Institute. Physician Data Query (PDQ). Laryngeal Cancer Treatment. November 21, 2019. Accessed at https://www.cancer.gov/types/head-and-neck/patient/adult/laryngeal-treatment-pdq on September 8, 2020. 

National Comprehensive Cancer Network (NCCN). NCCN Clinical Practice Guidelines in Oncology: Head and Neck Cancers. V.2.2020 – June 09, 2020. Accessed at www.nccn.org/professionals/physician_gls/pdf/head-and-neck.pdf on September 8, 2020. 

Last Revised: January 21, 2021

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