Chemotherapy for Oral Cavity and Oropharyngeal Cancer

Chemotherapy (chemo) is the use of anti-cancer drugs to treat cancer. It can be given as treatment for oral cavity and oropharyngeal cancers, either by itself or along with radiation therapy (known as chemoradiation).

How is chemo given?

Chemo drugs for oral cavity or oropharyngeal cancer are most often given into a vein (IV) or by mouth. This allows them to enter the bloodstream and reach most parts of the body. It can be done in a doctor’s office, infusion center, or hospital setting.

Chemo is often given using a slightly larger and sturdier IV known as a central venous catheter (CVC), central venous access device (CVAD), or central line. There are many different types of CVCs. The most common are the port and the PICC line. 

These are used to put medicines, blood products, nutrients, or fluids directly into your blood. They can also be used to take blood for tests.

Chemotherapy is given in cycles: one drug or a combination of drugs given on a set schedule, followed by a rest period. This period of chemo and rest is considered one cycle. The chemo schedule repeats to start the next cycle.

The exact schedule depends on the drugs used, but a common chemo cycle could be once a week, once every 3 weeks, or once every 4 weeks.

Common chemo drugs used to treat oral cavity or oropharyngeal cancer

The following chemo drugs are used most often for cancers of the oral cavity and oropharynx. These drugs can be given with or without radiation.

• Cisplatin (Platinol)
• Carboplatin (Paraplatin)
• 5-fluorouracil, 5-FU (Adrucil)
• Paclitaxel (Taxol)
• Docetaxel (Taxotere)

Other drugs that are used less often include:

• Methotrexate
• Capecitabine (Xeloda)

A chemo drug may be used alone or combined with other drugs. Combining drugs often shrinks tumors better but tends to cause more side effects. In certain cases, chemo might be given along with a targeted drug or immunotherapy.

Possible side effects of chemotherapy

Chemo drugs attack cells that divide quickly, which is why they work against cancer cells. But other cells in the body also divide quickly, including cells in the bone marrow, the lining of the mouth and intestines, and the hair follicles. This can lead to certain side effects.

These side effects vary depending on the type of chemo drugs, the dose, and the length of time they are given.

Common side effects

Common short-term side effects of chemo can include:

• Hair loss
• Mouth sores
• Loss of appetite or weight loss
• Nausea and vomiting
• Diarrhea
• Fever
• Rash
• Nail changes
• Skin changes

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

• Increased chance of infections, from low white blood cell counts
• Easy bruising or bleeding, from low blood platelet counts
• Fatigue, from low red blood cell counts

Side effects of specific chemo drugs

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

• 5-FU often causes diarrhea. This might need to be treated with drugs like loperamide.
• Cisplatin, docetaxel, and paclitaxel can cause nerve damage (called neuropathy), leading to numbness and tingling in the hands and feet. This often improves once treatment stops, but for some people it lasts a long time.
• Cisplatin can also cause kidney damage. To help prevent this, intravenous (IV) fluid is given before and after each dose.

Managing side effects

Chemo side effects usually go away over time after treatment ends. There are also ways to prevent or treat many of these side effects. Tell your cancer care team if you have side effects from chemo, so they can help you manage them. For example, many drugs are available to help prevent or treat nausea and vomiting.

In some cases, the doses of chemo drugs may be reduced or treatment may need to be delayed or stopped to keep side effects from getting worse.