Medical Oncology for Head and Neck Cancers

What is medical oncology?

Medical oncology is a type of medicine that focuses on the prevention, diagnosis, and treatment of cancer. Providers who work in medical oncology prescribe “systemic therapy” for cancer. Systemic therapy includes medications that go throughout your body. This is different from treatments like radiation and surgery which focus on one part of your body.

If you have head and neck cancer, systemic therapies can include

• Chemotherapy.
• Targeted therapy.
• Immunotherapy. 

These treatments may be given before or after surgery. They can also be given before, during, or after radiation therapy. Systemic therapies are most often used in advanced head and neck cancers.

Treatment Regimens for Head and Neck Cancer

Your treatment plan may include one medication, or a regimen. A regimen is a group of medications given together to treat your cancer. The regimen tells the provider how much of each medication you should get and how often. Cancers in different areas of the head and neck may be treated with different regimens.

Most regimens include a chemotherapy medication called cisplatin. Other common chemotherapy medications are: carboplatin, 5-FU, docetaxel, and paclitaxel.

Cetuximab is a targeted therapy that is often used in head and neck cancer treatment. This medication targets the EGFR receptor, which is found on many head and neck cancer cells. Larotrectinib is another type of targeted therapy that targets the NTRK genes.

Pembrolizumab and nivolumab are types of immunotherapy medications used to treat head and neck cancers.

In many cases, chemotherapy is given along with radiation. This is called chemoradiation. The chemotherapy is given for two reasons: to kill the cancer cells and to make them more sensitive to radiation (called radiosensitization).

Side Effects and Chemotherapy

Systemic treatments can cause side effects. Treatment affects everyone differently. Not everyone will have the same side effects. Some of the common side effects of systemic therapy include:

• Fatigue (feeling very tired) can start a few weeks into therapy. Fatigue often gets better slowly over the weeks and months following treatment.
• Nausea and vomiting: some treatments can make you feel sick. Talk to your care team so they can prescribe medications to help you control nausea and vomiting.
• Peripheral neuropathy  is when your hands or feet feel tingly or numb. It happens when nerves are damaged. Let your care team know if this happens, as they may adjust your medications.
• Hair loss: Your hair may become thin, brittle, or fall out. This often starts a few weeks after your first treatment.
• Change in appetite: You may not feel like eating. Food may taste different, even metallic. A dietitian can help you with these changes. Taste changes often get better, but it can take up to a year for some people.
• Changes in blood counts: Chemotherapy can damage blood cells, leading to low levels of white blood cells, red blood cells, and platelets.

Side Effects and Targeted/Immunotherapy

• Targeted therapies have different side effects, which can include skin and nail changes and changes to your hair. 
• Immunotherapy medications have different side effects due to their effect on your immune system. Common side effects are:  (add links)
  • Skin reactions.
  • Diarrhea.
  • Flu-like symptoms.

Your care team will tell you which side effects need to be reported right away when being treated with immunotherapy.

These side effects may get better in the weeks to months after treatment. Some may last longer. Always talk to your care team about any side effects you are having so they can help you manage them.