Early Stage and Locally Advanced Nasopharyngeal Carcinoma Treatment from Present to Future: Where Are We and Where Are We Going?

Abstract

Opinion statementNasopharyngeal carcinoma (NPC) is a rare malignancy, endemic in China, that is commonly diagnosed in locally advanced scenarios. Its pathogenesis is strongly associated with Epstein-Barr virus (EBV), an infection for which measuring EBV plasma DNA levels has helped as a prognostic factor guiding treatment options, including a stronger treatment in those with high titers. Additionally, tobacco and alcohol are often implicated in EBV-negative patients. The local disease is treated with radiotherapy alone, preferentially intensity modulated radiotherapy. For locally advanced disease, the backbone treatment is concurrent chemoradiotherapy with the ongoing research dilemma being adding adjuvant chemotherapy or induction chemotherapy. The ongoing research is focused not only on identifying patients that will benefit from adjuvant or induction chemotherapy, but also on identifying the best chemotherapeutic regimen, regimen alternatives to diminish toxicity, the role that immune checkpoint inhibitors play, and the use of molecularly guided treatment targeting patients with NPC whether driven by EBV or tobacco and alcohol. Knowing the precise oncogenesis of NPC not only offers a better understanding of the role that EBV plays in this tumor but also helps create targeted therapies that could potentially block important pathways such as the NF-κB pathway. Much is yet to be done, but the prognosis and management of NPC patients have changed drastically, offering precise treatment methods and excellent control of the disease, even in locally advanced scenarios.

Modified synthetic peptides: from therapeutics to chemosensors

“…221 Additionally, LMP1-positive tumours are linked to poorer overall survival, with LMP1 serving as a robust risk factor for unfavourable prognosis in patients with nasopharyngeal cancer. 222 Other fluorescent/luminescent anti-cancer peptide probes have been reported for targeting discrete proteins. 223,224 However, these larger supramolecular structures will be discussed in more detail in the next section.…”

“…221 Additionally, LMP1-positive tumours are linked to poorer overall survival, with LMP1 serving as a robust risk factor for unfavourable prognosis in patients with nasopharyngeal cancer. 222…”