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Chemotherapy in Head and Neck Cancer

Learn about chemotherapy options for head and neck cancer, including neoadjuvant, concurrent, adjuvant, and palliative treatments. Explore different chemotherapeutic agents, their mechanisms, and potential side effects. Pre-treatment workup, including tests and examinations, is also discussed.

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Chemotherapy in Head and Neck Cancer

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  1. Chemotherapy in Head and Neck Cancer

  2. Introduction • 500,000 new cases of squamous cell cancer of the head and neck worldwide per year; 40,00 new cases per year in the United States

  3. How do they act?

  4. Classical chemotherapy is directed at metabolic sites essential to cell replication • Tumor Cells Replicate more frequently than normal cells • However, currently available chemotherapy does not specifically recognize neoplastic cells • Highest morbidities in rapidly dividing cells: bone marrow, GI mucosa, and hair cells

  5. CHEMOTHERAPY OPTIONS IN HEAD AND NECK CANCER Can use chemo in 4 main ways:- • Neoadjuvant (Induction) chemotherapy • Concurrent (Concomitant) chemotherapy • Adjuvant (Post-op) chemotherapy • Palliative chemotherapy

  6. Pre treatment work up • History and clinical examination • Haematological tests: Hb%, TC,DC, Platelet Count • Urine Examination • Biochemistry: BUN, S.Creartinine, LFT • Radiology: CXR, CT and MRI where needed • USG abdomen • ECG • Audiogram • Nutritional Status

  7. Chemotherapeutic Agents • Alkylating agents • Antimetabolites • Antitumor Antibiotics • Alkaloids • Taxanes

  8. Alkylating Agents • Influences the structure and function of DNA • Example:cyclophosphamidecisplatin ( Platinum compund)

  9. Cisplatin

  10. Cisplatin • Side Effects • Severe Nausea and Vomiting up to 5 days after administration • Nephrotoxicity- Usually the dose limiting toxicity • Ototoxicity – High Frequency Hearing Loss, Tinnitus • Neurotoxicity.

  11. Squamous cell ca • 80 – 120 mg / m2 every 3 weeks • Good prehydration

  12. Cyclophophamide • Squamous cell ca, lymphomas, leukemias • Haemorrhagic cystitis • N/v , alopecia, neutropenia

  13. Antimetabolites • Blocks nucleic acid synthesis • Example: methotrexate, 5FU

  14. Methotrexate

  15. Methotrexate • Toxicities: • Myelosupression, mucositis, alopecia, N/V and Diarrhea Most common • Renal Toxicity in Higher Doses

  16. 5 - Fluorouracil • Antimetabolite - Like Methotrexate deprives cells of essential precursors of DNA synthesis • Pyrimidine analog which has a stable flourine atom in place of hydrogen at position 5 of the uracil ring.

  17. 5-FU • Side Effects • MUCOSITIS • Other side effects include bone marrow supression, N/V, alopecia and anorexia

  18. Antitumor Antibiotics • Group of related antimicrobial compounds produced by Streptomyces species in culture • Doxorubicin • Bleomycin • Actinomycin D

  19. Doxorubicin • Lymphomas, sarcomas, esthesioneuroblastomas • Cardiotoxic • Alopecia, nausea, vomiting, diarrhoea

  20. Bleomycin • Squamous cell ca, Lymphoma • Pneumonitis, pulmonary fibrosis • Anaphylaxis, alopecia

  21. Actinomycin D • Rhabdomyosarcoma • Myelosupression • GI effects

  22. Alkaloids • Bind free tubulin resulting in arrest of cells in metaphase • Examples: vincristine, vinblastine

  23. Taxanes • Causes formation of abnormal bundles of microtubules. • Examples: paclitaxel and docetaxel

  24. THANK YOU

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