Biological therapy for mouth cancer

Biological therapy is treatment that changes the activity of cancer cells. It uses substances made naturally in the body or drugs that change how cells signal to each other to divide and grow. These therapies can control or destroy cancer cells.

Cetuximab (Erbitux) is a type of biological therapy known as a monoclonal antibody. It is designed to block areas on the surface of cancer cells that can trigger growth. These are called epidermal growth factor receptors (EGFR). Blocking these receptors can stop the signals that tell the cancer to grow. Trials have shown that cetuximab combined with radiotherapy can help people with locally advanced head and neck cancer to live longer than radiotherapy alone.

The National Institute for Health and Clinical Excellence (NICE) and the Scottish Medicines Consortium (SMC) have approved the use of cetuximab, with radiotherapy, for locally advanced squamous cell head and neck cancer. They have approved it for people when platinum based chemotherapy (such as cisplatin or carboplatin) is not working, or cannot be used. Locally advanced cancer means cancer that has spread into the areas close to the mouth or oropharynx. But the cancer has not spread to other areas of the body such as the bone or distant lymph nodes.

Cetuximab is also used in combination with platinum based chemotherapy. It is for people with squamous cell head and neck cancer that has come back or has spread. The decision to approve cetuximab in this situation was based on the results of a large international trial called EXTREME. The trial compared cetuximab and chemotherapy to chemotherapy alone. Patients on this trial hadn't been treated before with chemotherapy. The results suggested that adding cetuximab to chemotherapy helped people to live between 2 and 3 months longer than if they just had chemotherapy on its own. But in 2009 the SMC in Scotland and NICE in England decided not to recommend cetuximab for this group of patients on the NHS because it is not cost effective, so it is not widely used.

Newer biological therapies are being used in trials for head and neck cancer, including mouth and oropharyngeal cancer. The therapies include gefitinib (Iressa), zalutumumab, everolimus (Afinitor) and a modified virus called Reolysin. You can find information about these on the mouth and oropharyngeal cancer research page.

The side effects depend on which biological therapy you have but may include

• Tiredness (fatigue)
• Diarrhoea
• Skin changes (rashes or discolouration) – rashes may be severe for some people
• A sore mouth
• Weakness
• Loss of appetite
• Low blood counts
• Swelling of parts of the body, due to fluid build up

Tell your doctor or nurse if you have any of these effects. You can have medicines to help to control them. There is information about the side effects of individual biological therapies in our biological therapy section.

Look at the main biological therapy section for detailed information. You can ask your doctor or specialist nurse to write down the names of the drugs you will have. You can then look them up in our specific cancer drug section. There are pages there for all the most commonly used biological therapy drugs. Each page has information about the common, occasional and rare side effects of that drug.

Our mouth and oropharyngeal cancer organisations page gives details of people who can give you information about biological therapies. Some organisations can put you in touch with a cancer support group. Our mouth and oropharyngeal cancer reading list has information about books and leaflets on cancer treatments.