Chemotherapy for Salivary Gland Cancer

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. Chemo is not often used to treat salivary gland cancers.

For people with salivary gland cancers, chemo is most often used when the cancer has spread (metastasized) to distant organs or if it could not be controlled by surgery and radiation therapy. Chemo sometimes shrinks the tumors, but it’s not likely to cure this type of cancer.

Some chemo drugs help make cancer cells more easily killed by radiation. These drugs may be given along with radiation therapy (called chemoradiation) to treat salivary cancers that are at high risk for coming back after surgery.

Doctors give chemo in cycles, with each period of treatment followed by a rest period to give the body time to recover. Chemo cycles generally last about 3 to 4 weeks. Chemo may not be recommended for patients in poor health, but advanced age by itself should not keep you from getting chemo.

Some of the chemo drugs used to treat salivary gland cancers include:

• Cisplatin
• Carboplatin
• Doxorubicin (Adriamycin®)
• 5-fluorouracil (5-FU)
• Cyclophosphamide (Cytoxan®)
• Paclitaxel (Taxol®)
• Docetaxel (Taxotere®)
• Vinorelbine (Navelbine®)
• Methotrexate

These drugs may be used alone, but are more often given in combinations of 2 or more drugs. Because salivary gland cancers are not common, no large studies have been done to prove one chemo plan is better than the others. The situation is also complicated by the fact that there are different types of salivary gland cancers. The best way to use chemotherapy to treat salivary gland cancer is not clear. New chemo drugs and combinations of drugs are being studied in clinical trials.

Possible side effects of chemotherapy

Chemo drugs attack 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 (where new blood cells are made), 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 chemo depend on the type and dose of drugs given and the length of time they are used. Common side effects include:

• Hair loss
• Mouth sores
• Loss of appetite
• Nausea and vomiting
• Diarrhea or constipation
• Increased chance of infections (from having too few white blood cells)
• Easy bruising or bleeding (from having too few blood platelets)
• Fatigue (from having too few red blood cells)

There are often ways to lessen these side effects, and they usually go away over time after treatment ends. Be sure to ask your doctor or nurse what can be done to help reduce side effects, and let them know when you do have side effects so they can be managed . For example, drugs can be given to help prevent or reduce nausea and vomiting.

Some drugs can have other side effects. For example, cisplatin, carboplatin, and paclitaxel can damage nerves (called neuropathy). This can sometimes lead to hearing loss or problems in the hands and feet such as pain, burning or tingling sensations, sensitivity to cold or heat, or weakness. In most cases this gets better or goes away once treatment stops, but it can last a long time in some people. You should report this to your medical team, as well as any other problems you have while getting chemo, so that they can be treated right away. In some cases, the doses of the chemo drugs may need to be reduced or treatment may need to be delayed or stopped to keep the effects from getting worse.

More information about chemotherapy

To learn more about how chemotherapy is used to treat cancer, see Chemotherapy.

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