Recurrent/Metastatic Nasopharyngeal Carcinoma Treatment from Present to Future: Where Are We and Where Are We Heading?

Abstract

Opinion statementNasopharyngeal carcinoma (NPC) is distinct in its anatomic location and biology from other epithelial head and neck cancer (HNC). There are 3 WHO subtypes, which considers the presence of Epstein-Barr virus (EBV) and other histopathology features. Despite the survival benefit obtained from modern treatment modalities and techniques specifically in the local and locally advanced setting, a number of patients with this disease will recur and subsequently die of distant metastasis, locoregional relapse, or both. In the recurrent setting, the ideal therapy approach continues to be a topic of discussion and current recommendations are platinum-based combination chemotherapy. Phase III clinical trials which led to the approval of pembrolizumab or nivolumab for head and neck squamous cell carcinoma (HNSCC) specifically excluded NPC. No immune checkpoint inhibitor therapy, to date, has been approved by the FDA to treat NPC although the National Comprehensive Cancer Network (NCCN) recommendations do include use of these agents. Hence, this remains the major challenge for treatment options. Nasopharyngeal carcinoma is challenging as it is really 3 different diseases, and much research is required to determine best options and sequencing of those options. This article is going to address the data to date and discuss ongoing research in EBV + and EBV – inoperable recurrent/metastatic NPC patients.

Long noncoding RNA TMPO-AS1 upregulates BCAT1 expression to promote cell proliferation in nasopharyngeal carcinoma via microRNA let-7c-5p

“…According to the data of the International Agency for Research on Cancer, there were approximately 133,354 newly diagnosed NPC cases worldwide in 2020 [ 3 ]. Risk factors for NPC include Epstein-Barr virus infection, genetic predisposition, smoking and consumption of salt-cured food [ 4 ]. While radiotherapy and chemotherapy have improved patient outcomes, recurrence and distant metastases remain significant challenges for patients with NPC [ 5 ].…”

The Readability and Quality of Web-Based Patient Information on Nasopharyngeal Carcinoma: Quantitative Content Analysis

“…The development of NPC involves a complex interplay between genetic susceptibility; environmental factors, such as dietary habits or the use of cigarettes; and EBV infection [ 15 - 19 ]. Typically, the treatment for NPC involves radiotherapy as the primary therapy, along with chemotherapy, adjuvant therapies, and surgical intervention for primary or recurrent lesions [ 16 , 17 , 20 , 21 ]. Diagnosis for most patients occurs in the mid to late disease stages when more obvious symptoms begin to appear and the cancer has begun to affect the surrounding organs [ 22 ].…”