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.

When you might have targeted and immunotherapy drugs for mouth and oropharyngeal cancer

Whether you have targeted therapy and immunotherapy will depend on:

the type of mouth or oropharyngeal cancer you have
how far the cancer has grown (the stage)
treatment you may have already had
whether your cancer has certain proteins

Targeted cancer drug

You might have a targeted drug for squamous cell mouth and oropharyngeal cancer that is locally advanced.

You might also have it for squamous cell mouth cancer that:

has come back (recurrent or relapsed cancer)
has spread to other parts of the body (metastatic cancer)

Immunotherapy

You might have immunotherapy for squamous cell mouth and oropharyngeal cancer that:

has come back (recurrent or relapsed cancer)
has spread to other parts of the body (metastatic cancer)

Squamous cell cancer is the most common type of mouth and oropharyngeal cancer.

Tests on your cancer cells

Doctors look for certain proteins on the surface of your mouth and oropharyngeal cancer cells. They help the cells to grow and divide. They look for the:

epidermal growth factor receptor (EGFR) protein
programmed cell death ligand 1 (PDL-1) checkpoint protein

They usually test a sample of your mouth and oropharyngeal cancer tissue from when you were first diagnosed. Or from your operation if you had one.

The results of the tests show whether a targeted cancer drug or immunotherapy is suitable for you.

If your cancer has a particular protein on its surface, your doctor will call it positive for the protein. For example, PDL-1 positive.

Types of targeted and immunotherapy drugs for mouth and oropharyngeal cancer

Cetuximab

Cetuximab is a targeted cancer drug used for mouth and oropharyngeal cancer. It is a type of targeted drug called a monoclonal antibody. It targets the epidermal growth factor receptor (EGFR) and blocks it.

EGFR is a protein on the surface of cells. It helps the cells to grow and divide. Some cells have a fault in the EGFR gene. This causes it to signal to the cancer cells to divide and make more copies (replicate).

By blocking this protein, cetuximab stops the cancer cells from growing.

Diagram showing a monoclonal antibody attached to a cancer cell

You might have cetuximab:

with radiotherapy for locally advanced squamous cell mouth and oropharyngeal cancer
with platinum chemotherapy for squamous cell mouth cancer that has come back or has spread to other parts of the body (metastatic)

Pembrolizumab and nivolumab

Pembrolizumab and nivolumab are immunotherapy drugs called PD-1 inhibitors. They target and block a checkpoint protein called PD-1 on the surface of T cells. Checkpoint proteins are found on the surface of cells. PD-1 is found on the body's T cells, and PD-L1 is found on normal and often cancer cells. PD-1 means programmed cell death protein 1, and PD-L1 means programmed cell death ligand 1.

PD-L1 usually binds with PD-1. When PD-L1 on a cancer cell binds with PD-1, it prevents the T cell from recognising the cell as a cancer cell. The T cell sees it as a normal cell and leaves the cell alone. So, it prevents the T cell from killing the cancer cell.

Blocking the binding of PD-L1 to PD-1 with drugs called immune checkpoint inhibitors allows the T cells to recognise and kill cancer cells.

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Transcript

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.

You might have pembrolizumab if you have squamous cell cancer and:

you haven’t had any treatment for an advanced cancer
your cancer has come back and you can’t have surgery to remove the cancer
the cancer shows a type of protein called programmed cell death ligand 1 (PD-L1)

You have nivolumab if you have squamous cell cancer and:

your cancer has come back or has spread to other parts of the body
you 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.

Are these drugs available in the UK?

New cancer drugs are licensed for use in a particular way. For example, a drug might have a license to treat a particular stage of cervical cancer.

Once a drug has a license, several independent organisations approve the new cancer drugs before doctors can prescribe them on the NHS.

In England, the National Institute for Health and Care Excellence (NICE) decides which drugs and treatments are available on the NHS.

In Wales, the All Wales Medicines Strategy Group (AWMSG) advises NHS Wales. They generally follow NICE decisions but can also issue their own guidance.

The Scottish Medicines Consortium (SMC) advises NHS Scotland. Its decisions are separate from decisions made by NICE.

Not all targeted and immunotherapy drugs are available throughout the UK. It might depend on where you live whether you can have a certain drug. Your doctor can tell you what drug is available for you.

How you have targeted and immunotherapy treatment

You have treatment through a thin short tube (a cannula) that goes into a vein in your arm each time you have treatment.

Or you might have treatment through a long line: a central line, a PICC line or a portacath. These are long plastic tubes that give the drug into a large vein in your chest. The tube stays in place throughout the course of treatment.

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.

For more information about the side effects of your treatment, go to the individual drug pages.