Chemotherapy for Nasopharyngeal Cancer

How is chemotherapy used to treat nasopharyngeal cancers?

Chemo can be used in several different ways to treat nasopharyngeal cancer (NPC):

• Chemoradiation is chemo given along with radiation therapy. This is the main treatment for more advanced stages of NPC.
• Induction chemotherapy is given as the first treatment before chemoradiation. This method can help some people with NPC live longer.
• Adjuvant chemotherapy is given after radiation or chemoradiation.

Chemo can also be given alone or in combination with either targeted therapy or immunotherapy to treat NPC that cannot be surgically removed (unresectable), has spread to beyond the head and neck area (metastatic), or has come back after initial treatment (recurrent).

How is chemo given?

Chemo drugs are most often given into a vein (IV) or by mouth, which allows them to enter the bloodstream and reach most parts of the body. This 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 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 NPC

Cisplatin is the chemo drug used most often to treat NPC. It can be used alone or as part of chemoradiation (see below). It may be combined with another chemo drug to be given after chemoradiation or as induction chemotherapy.

Carboplatin is sometimes used if cisplatin is not a good choice. 

Other drugs might also be helpful in treating NPC with or without radiation, including:

• Gemcitabine (Gemzar)
• Docetaxel (Taxotere)
• Fluorouracil, 5-FU (Adrucil)
• Capecitabine (Xeloda)
• Paclitaxel (Taxol)

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.

Chemoradiation for NPC

Chemoradiation is chemotherapy given at the same time as radiation.

It has been shown to shrink nasopharyngeal tumors more than either treatment alone. This combined approach is helpful for people whose cancers are locally advanced, but it can be hard to tolerate, especially for people in poor health.

A preferred schedule is a dose of the chemo drug cisplatin every 3 weeks during radiation. For people who can’t tolerate cisplatin, carboplatin might be used with radiation instead.

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
• Nausea and vomiting
• Diarrhea
• Fever
• Rash

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 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 treatment with drugs like loperamide.
• Cisplatin, docetaxel, and paclitaxel can cause nerve damage (neuropathy), leading to hearing loss or 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 damage the kidneys. 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.