Abstract
Over the last few years, certain areas in the management nasopharyngeal carcinoma (NPC) that have an impact on the care of these patients have evolved, particularly with regard to liquid biopsies, minimally invasive surgery, and advances in chemotherapy and immunotherapy. Beyond its proven role in the diagnostics, surveillance, and treatment of NPC, liquid biopsy with plasma Epstein–Barr virus DNA in the screening of high-risk populations for NPC is strongly supported by recent evidence. Surgery of the nasopharynx is reserved for locally recurrent NPC, and in recent years there have been great strides in minimally invasive techniques with survival rates similar to those of open techniques in treating NPC. Induction chemotherapy in a recent pooled analysis was shown to be superior to concurrent chemotherapy alone for locoregionally advanced NPC. Finally, immunotherapy with a PD-1 inhibitor in NPC has been shown to have 1-year overall survival rates comparable to those of other patients with heavily pre-treated metastatic or recurrent NPC. In this commentary, we discuss these recent advances and their potential in the clinical management of patients with NPC.
Highlights
Nasopharyngeal carcinoma (NPC) has a distinct geographical pattern of incidence
There have been a number of advances in the management of NPC in screening, minimally invasive surgery, and immunotherapy that we are going to discuss in this review
Pre, mid, and post-treatment levels of plasma Epstein–Barr virus (EBV) DNA11–14 have been evaluated for their prognostication values in patients with NPC
Summary
Nasopharyngeal carcinoma (NPC) has a distinct geographical pattern of incidence. It is most prevalent in Southern China, where the annual incidence is about 30 cases per 100,000 persons[1], in contrast to fewer than 1 case per 100,000 persons in the US and Europe[2]. It is used as an adjunct[10] to endoscopy and imaging for surveillance of recurrence after radical treatment. To further understand the role of the brush system in detecting locally persistent or recurrent disease, the same system is being trialed in sensitivity and specificity of a combination EBV DNA and methylation markers in both a nasopharyngeal brush and plasma (ClinicalTrials.gov Identifier: NCT03379610). With the detection of NPC at earlier stages, these minimally invasive approaches may provide an opportunity to explore the role of primary surgery in NPC, similar to the treatment of another virally mediated head and neck cancer (human papilloma virus-positive oropharyngeal carcinoma). Nivolumab and ipilimumab (CTLA-4 inhibitor) as a combinatorial therapy are being evaluated in rare tumors that include NPC (ClinicalTrials.gov Identifier: NCT02834013), and nivolumab with chemoradiation in advanced-stage NPC is being evaluated in a phase 2 clinical trial (ClinicalTrials.gov Identifier: NCT03267498) and in a randomized phase 3 trial of adjuvant PD-1 antibody or observation in patients with locoregional advanced NPC (ClinicalTrials.gov Identifier: NCT03427827)
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