Chemotherapy and Other Systemic Therapies for Mouth (Oral) Cancer

MSK is a leader in developing new systemic therapies for treating mouth (oral) cancer.
A chemotherapy bag at an MSK infusion suite.
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Overview

Mouth cancer chemotherapy (chemo), targeted therapy, and immunotherapy are called systemic therapies. They travel through the bloodstream to treat mouth cancer cells anywhere in the body. 

Your care team may recommend systemic therapies to treat mouth cancer. 

You may have neoadjuvant (NEE-oh-A-joo-vant) systemic therapy, which is treatment you get before mouth cancer surgery. Neoadjuvant therapy shrinks tumors so they’re easier and safer to remove during surgery.  

You may also have adjuvant (A-joo-vunt) systemic therapy, which is treatment you get after mouth cancer surgery. It’s used to kill any cancer cells left after surgery. Adjuvant therapy can lower the risk of mouth cancer coming back or spreading. 

You may have chemotherapy along with radiation, a treatment called chemoradiation. In general, chemoradiation is after surgery.

Your care team will talk with you about whether that’s right for you. Your treatment plan is based on your overall health, the cancer’s stage and size, and the tumor’s genetics. 

MSK’s medical oncologists (cancer doctors) use the latest methods to treat mouth cancer. This includes research studies, also known as clinical trials, of new therapies and drug combinations.  

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Chemotherapy for mouth cancer

What is chemotherapy (chemo)?

Chemotherapy (chemo) is a treatment that uses strong medicine to stop or slow cancer cells from growing. Chemo puts medicine that targets cancer cells into your vein through an IV, or sometimes a pill. The medicines travel in your bloodstream to kill cancer cells in the body.   

There are many kinds of chemo medicines for mouth cancer. Your care team will talk with you about the best options.  

In general, chemotherapy medicines treat mouth cancer by affecting how cancer cells grow and spread.  

There are many types of chemotherapy medicines, and they do not work in the same way.  

They have different doses and schedules. Some are used alone, while others are used along with other medicines. There also are differences in how well chemo medicines work. 

The most common chemo drugs for head and neck cancers include:

  • Cisplatin (Platinol®)
  • Fluorouracil (Aluodrucil®)
  • Carboplatin
  • Paclitaxel (Abraxane®, Onxol®)
  • Docetaxel (Docefrez®, Taxotere®)
  • Methotrexate (Rheumatrex®, Trexall®) 
Video | :40 Head and neck surgeon Dr. Thomas Ow on how MSK uses treatments before surgery for better results

Chemo or immunotherapy before surgery can shrink tumors and make them easier to remove with surgery. 

Thomas Ow:
The most exciting developments in the field really revolve around using chemotherapies and
immunotherapies pre-operatively to shrink tumors, make things smaller, so that when we do
surgery, the surgeries are much less complex. And we're finding that in many cases for many
different kinds of cancer, that often results in better survival outcomes as well.
At MSK, every specialty is at the forefront and when we work together to make a treatment
plan for each patient, they can be assured that they're getting the most advanced care from the
entire team.

Watch this video at https://customer-do46zy3q1cub6422.cloudflarestream.com/488c69a28f5173127d6f659fcfc88ef7/watch
Chemotherapy medicines and regimens

If chemotherapy is a part of your treatment, your medical oncologist (cancer doctor) will recommend a chemotherapy plan. It’s also called a chemotherapy regimen (REH-jih-men).  

This treatment plan tells you important details, including: 

  • Which medicines you’ll get. 
  • The order in which you’ll get them. 
  • The dose (amount) of each drug. 
  • How often and how long you’ll need chemotherapy. 
  • Supportive medicine, such as drugs for nausea, to help you tolerate treatment better.  
Your care team will make a chemotherapy treatment plan. It’s based on things such as the type of cancer you have and how far the cancer has spread: 
Chemotherapy for early-stage mouth cancer 
Your care team may recommend chemotherapy before oral surgery (neoadjuvant chemo) or after oral surgery (adjuvant chemo).   
Chemotherapy for early-stage mouth cancer 

Early-stage oral cancer most often is treated with surgery, and sometimes radiation therapy.  

For stage 1 or stage 2 oral cancer, chemo is an option and is most often used with radiation. This is called chemoradiation. Cisplatin (Platinol®) is the standard chemotherapy drug used as part of chemoradiation. 

Chemoradiation can treat oral tumors better than chemo or radiation alone. Chemoradiation lowers the risk of cancer coming back. 

Many people have 2 or 3 doses of the chemo drug cisplatin during radiation. It’s given every 3 weeks. Sometimes cisplatin is given once a week for 6 to 7 weeks. Your care team will help choose the best regimen of cisplatin for your treatment.

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Chemotherapy for later-stage mouth cancer 
Chemotherapy for early-stage mouth cancer 

Early-stage oral cancer most often is treated with surgery, and sometimes radiation therapy.  

For stage 1 or stage 2 oral cancer, chemo is an option and is most often used with radiation. This is called chemoradiation. Cisplatin (Platinol®) is the standard chemotherapy drug used as part of chemoradiation. 

Chemoradiation can treat oral tumors better than chemo or radiation alone. Chemoradiation lowers the risk of cancer coming back. 

Many people have 2 or 3 doses of the chemo drug cisplatin during radiation. It’s given every 3 weeks. Sometimes cisplatin is given once a week for 6 to 7 weeks. Your care team will help choose the best regimen of cisplatin for your treatment.

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Chemotherapy for later-stage mouth cancer 
Chemotherapy for later-stage mouth cancer 
Chemotherapy can slow down or stop a tumor’s growth and help with symptoms. 
Chemotherapy for later-stage mouth cancer 

Later-stage cancer includes metastatic cancer. That means the cancer has spread to other parts of the body.  

With some stage 3 or stage 4 oral cancers, the cancer is in many parts of the mouth. Neoadjuvant chemo may help improve surgery results. You may have chemoradiation after surgery. 

There are a few options for stage 4 oral cancers that spread to nearby tissue, lymph nodes, or other areas in the body. You may have chemo alone, chemo with other systemic therapies, chemoradiation, or chemo after radiation. Some metastatic mouth cancers are treated with chemotherapy, targeted therapy, and immunotherapy. 
Chemotherapy for later-stage mouth cancer 

Later-stage cancer includes metastatic cancer. That means the cancer has spread to other parts of the body.  

With some stage 3 or stage 4 oral cancers, the cancer is in many parts of the mouth. Neoadjuvant chemo may help improve surgery results. You may have chemoradiation after surgery. 

There are a few options for stage 4 oral cancers that spread to nearby tissue, lymph nodes, or other areas in the body. You may have chemo alone, chemo with other systemic therapies, chemoradiation, or chemo after radiation. Some metastatic mouth cancers are treated with chemotherapy, targeted therapy, and immunotherapy. 

One of the hardest things about cancer is all the uncertainty. My job is to help reassure patients they have a whole team behind them who can spend the time to answer all of their questions.
Head and neck medical oncologist Dr. Michael Hwang offers chemotherapy, immunotherapy, and targeted therapies.

Are there side effects to mouth cancer chemotherapy?

Chemo most often works by attacking cells that divide very fast. Its goal is to kill cancer cells, which divide fast. But it may also harm healthy cells that divide fast. That includes the cells that make your hair grow. 

That’s why hair loss can be a side effect of some, but not all, chemotherapy for oral cancers. MSK offers  scalp cooling as a way to help with hair loss. It involves wearing a cold cap on your head before, during, and after getting chemo.

Other possible side effects from mouth cancer chemotherapy are:   

  • Fatigue (feeling very tired). 
  • Nausea (feeling like throwing up). 
  • Vomiting (throwing up). 
  • Not wanting to eat. 
  • Neuropathy (numbness or tingling in hands and feet). 
  • Low blood counts.  

Whether you have side effects from mouth cancer chemo depends on your treatment plan. 

We have more information on managing the side effects of chemo. 

We have ways to help manage nausea during chemotherapy. Our supportive care team will help manage the symptoms and side effects of cancer treatment.  

Rehabilitation medicine doctor Jesuel Padro-Guzman is with his patient at MSK in New York City. 
Chemotherapy-Induced Peripheral Neuropathy (CIPN) may start while you’re still getting chemotherapy, or months after treatment ends.
Rehabilitation medicine doctor Jesuel Padro-Guzman cares for many people with CIPN, a common side effect of chemotherapy. This nerve problem can cause weakness, numbness, pain, and tingling. It’s sometimes called chemo feet and chemo hands.
Learn more

Which MSK locations offer chemotherapy?

Where you get chemotherapy depends on the kind you’re getting, where you live, and other things.  

You may have your treatment at home, at your doctor’s office, in the hospital, or at one of our MSK regional locations.   

We know your life is busy and it’s stressful to fit chemotherapy sessions into your schedule. We offer chemotherapy at our locations in: 

  • New York City 
  • Long Island 
  • Brooklyn 
  • Westchester 
  • New Jersey  
THE MSK DIFFERENCE

Our Integrative Medicine and Wellness Service offers complementary, natural, and holistic treatments. They include  acupuncture, meditation, massage therapy, yoga, and exercise. Without using prescription drugs, integrative therapies can help manage the side effects of mouth cancer treatment.  

Targeted therapy for mouth cancer

What is targeted therapy?

Targeted therapies are cancer treatments that target a tumor’s gene changes (mutations or variants). It’s a personal treatment plan just for the type of cancer you have. Targeted therapy medicines most often are given by mouth in pill form or into your vein through an IV.  

Targeted therapies also are called personal medicine, precision medicine, or precision oncology.  

Oral cancer research is finding more drugs that work by targeting certain molecules that make oral cancer cells grow and divide. Targeted drugs attack the mutated proteins in cancer cells caused by tumor gene changes. They slow or stop their growth. Compared to chemo, targeted therapy does not affect most healthy cells.  

Targeting EGFR in mouth cancer

Mouth cancers have a higher amount of a protein called epidermal growth factor receptor (EGFR). This protein helps cancer cells grow. Targeted therapy stops EGFR from helping cancer cells grow.  

Cetuximab and panitumumab are examples of drugs used to target EGFR head and neck cancers.  

Cetuximab also is used with radiation therapy, most often during adjuvant treatment. 

Genomic testing for targeted therapy

Genomic testing tells us which mutations may have caused the mouth cancer. This information lets us target those genes for treatment.  

Genomic testing tells us if a tumor has mutated cancer cells. These mutations often are not inherited, and they make cancer grow.   

At MSK, genetic testing is a routine part of diagnosis for people who have advanced oral cancers. This testing can be done on tumor tissue. We also can test your blood samples we collect during a visit.  

We test tumors using MSK-IMPACT ®. It’s a testing tool only offered at MSK. This genetic testing looks for the most common mutations linked to mouth cancers. 

MSK-IMPACT finds genetic changes and other tumor traits that other tests can miss. We routinely test for changes in more than 500 genes.  

Using MSK-IMPACT, our researchers found that about 13 out of every 100 head and neck cancers have a mutation in the PIK3CA gene. That number is even higher in tumors related to human papillomavirus (HPV). We’re exploring new ways to target that mutation. 

Mutations of the EGFR gene are most common in oral cancer. Other gene mutations found in oral cancers include:

  • TP53
  • CDKN2A
  • PIK3CA
  • NOTCH1 

Mouth cancer targeted therapy side effects

Targeted therapies in general do not cause hair loss. Targeted therapies also are much less likely to have other common side effects of chemotherapy, such as low blood counts.  

Common side effects of targeted therapy can include: 

  • Fatigue (feeling tired) 
  • Gastrointestinal (stomach and intestinal) problems. They include nausea (feeling like throwing up) and diarrhea (loose bowel movement). 

Some targeted therapy drugs have other side effects because they target proteins also found in normal cells. For example, drugs that target EGFR can cause a rash.

Your care team will talk with you about what side effects to expect. They have a lot of experience in managing side effects. They offer treatments that can help you feel better. Examples are drugs that help with nausea, and integrative medicine treatments.  

Headshot of radiation oncologist Dr. Nadeem Riaz at MSK in NYC, wearing a doctors’ white coat.
This could be a completely new way to change the tumor and its microenvironment. It’s easy to add antibiotics to treatment to overcome resistance in some patients.
Radiation oncologist Dr. Nadeem Riaz led MSK research on head and neck squamous cell carcinoma. They learned bacteria inside tumors can make tumors resist immunotherapy. MSK is researching whether antibiotics before surgery can treat bacteria so immunotherapy works better.
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Immunotherapy for mouth cancer

What is immunotherapy?

Immunotherapy boosts your immune system’s natural ability to fight cancer. It helps your immune system attack cancer cells, just like it fights bacteria or viruses.   

Checkpoint inhibitors unlock the checkpoint (barrier) that cancer puts on the immune system.

There are 2 checkpoint inhibitors for head and neck squamous cell cancer that come back after surgery, radiation, or both. They’re called nivolumab (Opdivo®) and pembrolizumab (Keytruda®).

Both block a protein called PD-1 found on immune cells. PD-1 acts like a brake on the immune system, causing a weaker immune response. Nivolumab and pembrolizumab release this brake and let the immune system fight cancer better. 

We may use a checkpoint inhibitor or immunotherapy alone or with chemo. Immunotherapy is given through an IV during a visit. It’s often used for advanced cancer.

MSK researchers study ways to use immunotherapy to treat head and neck cancer. You may be able to join  research studies, also known as clinical trials. Some may offer early access to promising immunotherapy treatments.   

Are there side effects to immunotherapy?

The most common side effects are caused by the immune system having a strong reaction to normal tissues. Side effects often are related to inflammation of normal tissue, and can include:  

  • Skin problems, such as a rash or itching. 
  • Chills, fatigue (feeling very tired), and other flu-like symptoms. 
  • Gastrointestinal problems, such as diarrhea (loose poop). 
  • Pain from joint inflammation (swelling).  

We can safely manage most side effects. We stop immunotherapy, often for a short period, and treat side effects early.  

Sometimes, side effects can cause harm. This can happen if they’re not treated fast and they involve vital (very important) organs, such as the lungs. Your care team will treat this and decide if and when you can restart immunotherapy.  

MSK doctors are experts in caring for people who have side effects from immunotherapy. 

Radiation oncologist Dr. Nancy Lee, smiling, is pictured at MSK wearing a white doctors’ coat.
It’s very exciting to see not just a significant improvement in survival but also less toxic follow-up treatments after surgery. Now some patients should be able to avoid chemotherapy.
Radiation oncologist Dr. Nancy Lee helped design a study for people with mostly stage 3 head and neck squamous cell carcinoma (HNSCC). An immunotherapy drug can stop the cancer from coming back, and let some people avoid chemo after surgery.
Learn more
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Mouth & Oral Cancer Radiation Therapy, Side Effects, Recovery & More
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