Treatments for recurrent oropharyngeal cancer

Recurrent oropharyngeal cancer means that the cancer has come back after it has been treated. The following are treatment options for recurrent oropharyngeal cancer. Your healthcare team will suggest treatments based on your needs and work with you to develop a treatment plan.

Treatment options depend on where the cancer comes back (recurs), the size of the cancer, which treatments you received for the original cancer and your overall health.

You may be offered surgery for oropharyngeal tumours that come back in the same place as the original tumour or in the neck. The goal of surgery is to remove the tumour.

A neck dissection removes the lymph nodes in the neck (cervical lymph nodes). It may be done if the cancer recurs in the lymph nodes.

Other surgeries may be offered to relieve symptoms or give supportive care for advanced oropharyngeal cancer. These include:

• placement of a feeding tube (usually with a gastrostomy) to make sure you get enough nutrients
• placement of a breathing tube (called a tracheostomy) to help you breathe

You may be offered radiation therapy for recurrent oropharyngeal cancer. It may be used as the main treatment if radiation wasn’t used to treat the original cancer. In some cases, it may be given again (called re-irradiation) even if it was used to treat the original cancer. Radiation therapy may also be given after surgery, either alone or with chemotherapy as part of chemoradiation.

You may be offered chemotherapy for recurrent oropharyngeal cancer. Cancer that cannot be removed by surgery or comes back in distant places is usually treated with chemotherapy. The following drugs may be used alone or in combination:

• cisplatin
• carboplatin
• fluorouracil (also called 5-fluorouracil or 5-FU)
• methotrexate
• paclitaxel
• docetaxel
• bleomycin
• ifosfamide (Ifex)

You may be offered chemoradiation for recurrent oropharyngeal cancer. In chemoradiation, chemotherapy is given during the same time period as radiation therapy. For recurrent oropharyngeal cancer, cisplatin is usually the chemotherapy drug given along with radiation to the tumour and lymph nodes on both sides of the neck.

You may be offered targeted therapy for recurrent oropharyngeal cancer. It may be given alone or with radiation therapy or chemotherapy. Cetuximab (Erbitux) is the most common targeted therapy drug used to treat oropharyngeal cancer.

Immunotherapy helps to strengthen or restore the immune system's ability to fight cancer. Immunotherapy may be used to treat recurrent oropharyngeal cancer.

Pembrolizumab (Keytruda) may be used as a first-line therapy to treat unresectable recurrent oropharyngeal cancer, with or without chemotherapy.

Nivolumab (Opdivo) is used to treat recurrent oropharyngeal cancer that has stopped responding to chemotherapy with platinum drugs such as cisplatin or carboplatin.

You may want to consider a type of care to make you feel better without treating the cancer itself. This may be because the cancer treatments don’t work anymore, they’re not likely to improve your condition or they may cause side effects that are hard to cope with. There may also be other reasons why you can’t have or don’t want cancer treatment.

Talk to your healthcare team. They can help you choose care and treatment for advanced cancer.

Talk to your doctor about clinical trials open to people with oropharyngeal cancer in Canada. Clinical trials look at new ways to prevent, find and treat cancer. Find out more about clinical trials.