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. Some chemo drugs may also make cancer cells more vulnerable to radiation.

Chemo 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. Chemo sometimes shrinks tumors in these patients, but it’s not likely to cure this type of cancer.

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 is often not recommended for patients in poor health, but advanced age by itself is not a barrier to 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®)
• 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 regimen is better than the others. The situation is also complicated by the fact that there are different types of salivary gland cancers. New chemo drugs and combinations of drugs are now 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 taken. These side effects can 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 after treatment is finished. 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. 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 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 stops, but it can last a long time in some people. You should report this to your medical team, as well as any other side effects 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 prevent the effects from getting worse.

For more information on chemo, see Chemotherapy.