Targeted and immunotherapy drugs for mouth and oropharyngeal cancer
Targeted cancer drugs work by targeting the differences in cancer cells that help them to grow and survive. Other drugs help the immune system to attack cancer. They are called immunotherapies.
Some drugs work in more than one way. So they are targeted as well as working with the immune system.
For mouth and oropharyngeal cancer, you might have:
- a targeted cancer drug called cetuximab (Erbitux)
- an immunotherapy drug such as nivolumab (Opdivo) or pembrolizumab (Keytruda)
When you might have targeted and immunotherapy drugs for mouth and oropharyngeal cancer
You might have targeted or immunotherapy drugs if your cancer has:
- spread into surrounding tissue or lymph nodes (locally advanced)
- spread to other parts of the body (advanced cancer)
- come back after treatment (recurrent or relapsed cancer)
You might have these treatments if you have a type of cancer called squamous cell cancer.
Squamous cell cancer is the most common type of mouth cancer.
Tests on your cancer cells
Your doctor might test your cancer cells for particular proteins. This can help to show whether certain drug treatments might work for your cancer.
To test your cancer cells, your specialist needs a sample (biopsy) of your cancer. They might have tested your cancer cells when you were first diagnosed. Or they might be able to test some tissue from a biopsy or operation you have already had.
In some cases, you might need to have a second biopsy.
Targeted cancer drugs
You might have a targeted cancer drug called cetuximab. This is a type of monoclonal antibody (MAB).
What are monoclonal antibodies (MABs)?
Antibodies are found naturally in our blood and help us to fight infection. MAB therapies mimic natural antibodies but are made in a laboratory. Monoclonal means all one type. So each MAB therapy is a lot of copies of one type of antibody.
How do MABS work?
MABs work by recognising and finding specific proteins on cancer cells.
Each MAB recognises one particular protein. So different MABs have to be made to target different types of cancer. Depending on the protein they are targeting, they work in different ways to kill the cancer cell or stop it from growing.
Cetuximab
You might have cetuximab with radiotherapy if you have a type of cancer called squamous cell cancer. And if your cancer has spread into surrounding tissues or lymph nodes (locally advanced).
You might have it in one of the following situations:
- your platinum chemotherapy (for example cisplatin or carboplatin) is not working
- you cannot have chemotherapy
If your cancer started in the mouth and has come back or spread, you might have cetuximab with chemotherapy. This treatment is not available everywhere in the UK.
Immunotherapy drugs
You may have the immunotherapy drugs nivolumab and pembrolizumab. They are a type of immunotherapy called checkpoint inhibitors.
Checkpoint inhibitors block proteins that stop the immune system from attacking the cancer cells.
Our immune system protects us from disease, killing bacteria and viruses.
It also helps fight cancer.
A T cell is one type of immune cell that does this.
T cells have proteins on them that turn the immune system on when it needs to fight infection
and other proteins that turn the immune system off when it is no longer needed. These are called checkpoints.
Cancer cells can trick the immune system by turning the T cells off
stopping them from recognising and attacking the cancer cells.
Drugs called checkpoint inhibitors turn the T cells back on
so they can recognise and attack the cancer cells.
For more information about checkpoint inhibitors click here.
When do you have pembrolizumab?
You may have pembrolizumab if you have squamous cell cancer and:
- you haven’t had any treatment for an advanced cancer, or your cancer has come back (recurred) and you have not had any treatment since it came back
- you can’t have surgery to remove the cancer
- the cancer shows a type of protein called PD-L1
You can take pembrolizumab it for up to 2 years if it continues to work and you don’t have severe side effects.
When do you have nivolumab?
Nivolumab is available on the NHS in the UK. In England, Wales and Northern Ireland, you can have nivolumab if you have:
- squamous cell cancer that has come back or spread to other parts of the body
- had platinum based chemotherapy (such as cisplatin or carboplatin) and your cancer has started to grow within 6 months of having chemotherapy
In Scotland, the Scottish Medicines Consortium (SMC) says that you can have nivolumab if your cancer continues to grow while on or after having platinum based chemotherapy. You can have it for up to 2 years.
Side effects
Everyone is different and the side effects vary from person to person. The side effects you have depend on:
- which drug you have
- whether you have it alone or with other drugs
- the amount of drug you have (the dose)
- your general health
A side effect may get better or worse during your course of treatment. Or more side effects may develop as the treatment goes on.
Your doctor, pharmacist or specialist nurse will talk through possible side effects.
For more information about the side effects of your treatment, go to the individual drug pages.
Other targeted cancer drugs
Researchers are looking at:
- new targeted and immunotherapy drugs such as durvalumab and levatinib
- different combinations of these drugs with other treatments
