Nasopharyngeal Carcinoma

Nasopharyngeal Carcinoma: overview

This algorithm outlines treatment of nasopharyngeal carcinoma, which is often EBV-associated, by stage. Early disease (T1 N0) is treated with definitive radiotherapy alone. For locally advanced disease (T2-4 and/or node positive), the chart shows two approaches: concurrent cisplatin with radiotherapy followed by adjuvant chemotherapy, the strategy established by Intergroup 0099, and induction gemcitabine plus cisplatin followed by concurrent chemoradiation. In the site's Intergroup 0099 summary, concurrent chemoradiation followed by adjuvant cisplatin and fluorouracil markedly improved 3-year PFS and OS compared with radiotherapy alone.

For recurrent or metastatic disease, first-line therapy is gemcitabine and cisplatin plus toripalimab (JUPITER-02), or gemcitabine and cisplatin with another PD-1 inhibitor such as camrelizumab (CAPTAIN-1st) or penpulimab. CAPTAIN-1st was the first phase III trial to show an OS benefit for an anti-PD-1 agent in this setting (HR 0.55). Toripalimab is shown for subsequent-line treatment after platinum.

Step by step

• Early disease (T1 N0): definitive radiotherapy alone.
• Locally advanced disease (T2-4 and/or N+): concurrent cisplatin plus radiotherapy, then adjuvant chemotherapy (Intergroup 0099).
• Locally advanced disease, alternative: induction gemcitabine plus cisplatin, then concurrent chemoradiation.
• Recurrent or metastatic, first line: gemcitabine and cisplatin plus toripalimab (JUPITER-02).
• Recurrent or metastatic, first line alternative: gemcitabine and cisplatin with another PD-1 inhibitor, camrelizumab (CAPTAIN-1st) or penpulimab.
• Recurrent or metastatic, subsequent line after platinum: toripalimab.

Trials behind this algorithm

• Intergroup 0099 Al-Sarraf M et al, JCO, 1998; PMID: 9552031
• JUPITER 02 Mai et al. Nature, 2021, 34341578
• CAPTAIN-1st Yang Y et al, Lancet Oncol, 2021; PMID: 34174189