CHEMOTHERAPY

HEAD AND NECK

CANCER
Dwi Antono
ENT-HNS Departement, Faculty of Medicine,
University of Diponegoro
Kariadi General Hospital
Semarang
Chemotherapy
Definition
01 type of cancer treatment that uses drugs to
destroy cancer cells

Works
02 Stopping or slowing the growth of cancer cells,
which grow and divide quickly

Side Effects
03 Healthy cells can also be affected by chemotherapy
treatments.

Goal
04 Eliminate the cancer cells, while minimizing
the negative effect on normal, healthy cells.

05 Treatment of the cancer not only

chemotherapy but also surgery and
radiation
Purpose
Shrink a tumor before surgery or radiation
▪ therapy.

Destroy microscopic cancer cells that may

▪ remain after surgery or radiation

Destroy cancer cells that have come back

▪ or spread to other parts of your body

Control tumor growth when a cure is not

▪ possible

Ease cancer symptoms, such as

▪ shrinking a tumor that is causing pain or
pressure
Help radiation therapy and biologic therapy 
▪ work better.
 Treatment Cycles
How often and how long you receive chemotherapy depends on

The type and stage The goals of treatment (whether

chemotherapy is used to cure
of cancer your cancer, control its growth,
or ease the symptoms)

The type of How your body reacts

chemotherapy to chemotherapy
 Principles of Systemic Therapy
Non Nasopharyngeal cancer

The choice of systemic Cisplatin based induction

therapy should be chemotherapy followed by
individualized based on high dose, every 3 week
patient characteristic cisplatin chemoradiotherapy
is associated with toxicity
concerns

The preferred
chemoradiotherapy
approach for fit patients After induction
with locally advanced chemotherapy, multiple
disease remain concurrent option can be used for the
cisplatin and radiotherapy radiation based portion of
therapy, including
radiotherapy alone,
Cisplatin based induction particularly for patients with
chemotherapy can be used, complete response after
followed by radiation based induction chemoterapy
locoregional treatment
 Primary Systemic Therapy + Concurrent RT

Useful in certain circumstances

Preferred Regimens Select ethmoid/maxillary sinus
• High dose cisplatin cancer(small cell, SNEC, high grade
• Carboplatin / infusional 5FU olfactory esthesioneuroblastoma,
SNUC with neuroendocrine feature) :
• Carboplatin / etoposide ±
concurrent RT
• Cisplatin / etoposide ± RT
• Cyclophosphamide / doxorubicin /
Other recommended regimens vincristine (followed by RT based
• 5FU/hydroxyurea treatment)
• Carboplatin / paclitaxel
• Cetuximab
• Cisplatin / infusional 5FU
• Cisplatin/ / paclitaxel
• Weekly cisplatin 40mg/m2
 Postoperative Systemic Therapy / RT

Useful in certain circumstances

Preferred Regimens • Docetaxel / cetuximab ( if
• Cisplatin cisplatin ineligible and positive
margins and/or extranodal
extension)

Other recommended regimens

• none
 Induction / Sequential Systemic Therapy

Preferred Regimens
• Docetaxel / cisplatin / 5FU

Other recommended regimens

• Paclitaxel / cisplatin / infusional 5FU
Systemic Therapy / RT following induction Therapy, or combinatio
n chemotherapy for reccurent / persistent disease

Preferred Regimens
• Weekly carboplatin + concurrent RT
• Weekly cisplatin + concurrent RT

Other recommended regimens

• Weekly cetuximab + concurrent RT
 Principles of Systemic Therapy
Non Nasopharyngeal Cancer : Reccurent, Unresectable, or Metastatic ( with no Surgery or RT option)
Lip, Oral Cavity, oropharynx, hypopharynx, Glottic Larynx, Supraglottic larynx, Ethmoid Sinus, Maxillary Sinus, Occult Primary

Preferred Regimens Preferred Regimens

(First Line) (Subsequent Line)

• Cetuximab / Platinum • Immunotherapy (if not

(cisplatin or carboplatin) / 5FU previously used)
• Immunotherapy : • Nivolumab if disease
• Pembrolizumab / progression on or after
platinum (cisplatin or platinum therapy
carboplatin) / 5FU • Pembrolizumab if
• Pembrolizumab (for disease progression on
tumors that express PD or after platinum
L1 with CPS≥1) therapy
 Cont….
Principles of Systemic Therapy
Non Nasopharyngeal Cancer : Reccurent, Unresectable, or Metastatic ( with no Surgery or RT option)
Lip, Oral Cavity, oropharynx, hypopharynx, Glottic Larynx, Supraglottic larynx, Ethmoid Sinus, Maxillary Sinus, Occult Primary

Other Recommended Other Recommended Useful in Certain

Regimens (First Line) (Subsequent Line) Circumstances (First and
Subsequent Line)
Combination Therapy • Carboplatin Combination Therapy or Single Agents For select ethmoid/maxillary sinus
• Cisplatin/cetuximab • Paclitaxel • See preferred and other cancers (small cell, SNEC, high-grade
• Cisplatin or • Docetaxel recommended first line therapy option olfactory esthesioneuroblastoma, SNUC
carboplatin/docetaxel or • 5FU above with neuroendocrine features) :
paclitaxel • Methotrexate Targeted Therapy • Cisplatin/etoposide or
• Cisplatin/5FU • Cetuximab • Afatinib if disease progression on or carboplatin.etoposide
• Cisplatin or • capecitabine after platinum therapy • cyclophosphamide/doxorubicin/vincris
carboplatin/docetaxel/c tine
etuximab
• Cisplatin or
carboplatin/paclitaxel/ce
tuximab
 Cont….
Principles of Systemic Therapy
Non Nasopharyngeal Cancer : Reccurent, Unresectable, or Metastatic ( with no Surgery or RT option)
Lip, Oral Cavity, oropharynx, hypopharynx, Glottic Larynx, Supraglottic larynx, Ethmoid Sinus, Maxillary Sinus, Occult Primary

Other Recommended Other Recommended

Regimens (First Line) (Subsequent Line)
Combination Therapy • Carboplatin Combination Therapy or Single Agents
• Cisplatin/cetuximab • Paclitaxel • See preferred and other
• Cisplatin or carboplatin/docetaxel or • Docetaxel recommended first line therapy option
paclitaxel • 5FU above
• Cisplatin/5FU • Methotrexate Targeted Therapy
• Cisplatin or • Cetuximab • Afatinib if disease progression on or
carboplatin/docetaxel/cetuximab • capecitabine after platinum therapy
• Cisplatin or
carboplatin/paclitaxel/cetuximab
 Principles of Systemic Therapy
Non Nasopharyngeal Cancer : Reccurent, Unresectable, or Metastatic ( with no Surgery or RT option)
Salivary Gland Tumors

Preferred Regimens Useful in certain

Circumstances
• None Androgen receptor therapy for AR + tumors
• Leuprolide
• Bicalutamide
NTRK therapy for NTRK gene fusion positive tumors
Other Recommended • Larotrectinib
• Entrectinib
Regimens HER2 targeted therapy for HER2+tumors
• Trastuzumab
• Chemotherapy (eg. Lenvatinib for adenoid cystic carcinoma
Cisplatin/vinorelbine, or
cisplatin/doxorubicin/cyclopho
sphamide
Principles of Systemic Therapy
Nasopharyngeal Cancer : Primary Definitive Therapy
 Principles of Systemic Therapy
Nasopharyngeal Cancer : Primary Definitive Therapy
Systemic Therapy / RT Followed by adjuvant Chemotherapy

Preferred Regimens Other Recommended

Regimens

• Cisplatin + RT followed by • Cisplatin + RT followed by

cisplatin/5FU carboplatin/5FU
• Cisplatin + RT without adjuvant
chemotherapy
 Principles of Systemic Therapy
Nasopharyngeal Cancer : Induction/sequential Systemic Therapy

Preferred Regimens Other Recommended

Regimens

• Gemcitabine/cisplatin • Cisplatin/5FU
• Docetaxel/cisplatin/5FU(do • Cisplatin/epirubicin/paclitaxel
se adjusted) • Docetaxel/cisplatin
• Following induction, agents used
with concurrent systemic
therapy/RT typically include
weekly cisplatin or carboplatin
 Principles of Systemic Therapy
Nasopharyngeal Cancer : Recurrent, Unresectable, or Metastatic (with no surgery or RT option)

Preferred Regimens Other Recommended Regimens(First

Line)

• Cisplatin/Gemcitabine Combination therapy • Cisplatin

• Cisplatin/5FU • Carboplatin
• Cisplatin or • Paclitaxel
carboplatin/docetaxel or • docetaxel
paclitaxel
• Carboplatin/cetuximab
• Gemcitabine/carboplati
n
 Cont….
Principles of Systemic Therapy
Nasopharyngeal Cancer : Recurrent, Unresectable, or Metastatic (with no surgery or RT option)

Preferred Regimens Other Recommended Regimens

(Subsequent Line) (Subsequent Line)

• none Combination Therapy or Single Agents

• See preferred and other recommended
first line therapy regimens
Immunotherapy
• Nivolumab if previously greated, recurrent
or metastatic non keratinizing disease
• Pembrolizumab if previously treated, PD-
L1 positive recurrent or metastatic disease
Thank you