Biological therapy for nasal and sinus cancer

Biological therapies are treatments that act on processes in cancer cells. They can work in different ways such as changing the way cells signal to each other or by stimulating the body to attack or control the growth of 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, if 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 lining of the nose or paranasal sinuses but not to other areas of the body such as the bone or distant lymph nodes.

Cetuximab is now also licensed in Europe for use in combination with platinum based chemotherapy, for treating people with squamous cell head and neck cancer that has come back or has spread. This decision was based on the results of a large international trial called EXTREME, which 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 nasal and paranasal sinus cancer. The therapies include gefitinib (Iressa), zalutumumab and everolimus (Afinitor). You can find information about these on the nasal and sinus cancer research page.

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

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