Nasopharyngeal carcinoma

Abstract

Epidemiological trends during the past decade suggest that although incidence of nasopharyngeal carcinoma is gradually declining, even in endemic regions, mortality from the disease has fallen substantially. This finding is probably a result of a combination of lifestyle modification, population screening coupled with better imaging, advances in radiotherapy, and effective systemic agents. In particular, intensity-modulated radiotherapy has driven the improvement in tumour control and reduction in toxic effects in survivors. Clinical use of Epstein-Barr virus (EBV) as a surrogate biomarker in nasopharyngeal carcinoma continues to increase, with quantitative assessment of circulating EBV DNA used for population screening, prognostication, and disease surveillance. Randomised trials are investigating the role of EBV DNA in stratification of patients for treatment intensification and deintensification. Among the exciting developments in nasopharyngeal carcinoma, vascular endothelial growth factor inhibition and novel immunotherapies targeted at immune checkpoint and EBV-specific tumour antigens offer promising alternatives to patients with metastatic disease.

Beating 'Guangdong cancer': a review and update on nasopharyngeal cancer

“…9 In endemic regions such as Hong Kong, non-keratinising carcinoma predominates, whereas the keratinising type is more common in other parts of the world. 10 Nasopharyngeal cancer is staged according to the tumour, node, metastasis system. To assist with the prognosis and guide treatment decisions, NPC can be further stratified into five different stages (stages I, II, III, IVA, and IVB), as suggested by the latest American Joint Committee on Cancer (8th edition) cancer staging manual.…”

“…This virus-as a primary aetiological agent of NPC, specifically the endemic non-keratinising type-has been supported by a large body of evidence 12 ; a review in 2012 suggested that EBV accounted for more than 85% of NPC cases globally. 13 Based on in-situ hybridisation techniques 10 and the fact that EBV infects more than 90% of the population, 14 EBV reactivation is considered necessary in the pathogenesis of NPC; inhibition of EBV reactivation is currently being investigated as a possible approach to preventing NPC relapse. 15 What triggers the reactivation, however, is less welldefined, although cigarette smoking is among the possible reactivating factors.…”

“…10 Of note, IMRT is currently the preferred approach, with its improved OS and decreased toxicity, 42 advantages in preserving parotid function and reducing severe xerostomia, 43 and improved quality of life compared with conventional two-dimensional (2D) RT. 44 It is currently used as a monotherapy for the early stage of NPC.…”

“…58 A platinumbased regimen is often used as the chemotherapy of choice, in which cisplatin is most commonly used. 10 While it is clear that chemotherapy is essential in the treatment of advanced NPC, its value as an add-on induction therapy (preceding CRT) and adjuvant therapy (following CRT) is less clear. Regarding induction therapy, a phase III trial recently showed that the addition of docetaxel, cisplatin, and fluorouracil prior to CRT was superior to CRT alone in terms of OS and PFS at 3 years, 59 although another trial using cisplatin and fluorouracil as induction therapy failed to show significant differences in OS.…”

“…Cisplatin and fluorouracil have been the conventional choices. 10 A recent study by Zhang et al 65 demonstrated that the combination of cisplatin plus gemcitabine was superior to the combination of cisplatin and fluorouracil, in terms of median PFS (7.0 vs 5.6 months; hazard ratio=0.55; 95% confidence interval, 0.44-0.68), although the cisplatin-gemcitabine group experienced more haematological toxicity, such as grade-3 or higher leukopenia, neutropenia, and thrombocytopenia. 65 This randomised controlled trial has thus established the role of cisplatin and gemcitabine combination as the chemotherapy of choice in recurrent or metastatic NPC.…”