The Evolving Role of Systemic Therapy in Nasopharyngeal Carcinoma: Current Strategies and Perspectives

Abstract

Treatment for nasopharyngeal carcinoma (NPC) has evolved tremendously over the last decade, owing to the integration of chemotherapy into the primary radiotherapy, improvement in tumor imaging and disease monitoring, and advances in high precision radiotherapy delivery. Several randomized trials have established concurrent chemoradiation (with or without adjuvant chemotherapy) as the standard of care in advanced NPC. Current efforts are building on these earlier trials, to further test the optimal strategy of integrating neoadjuvant or adjuvant chemotherapy to further improve patient’s survival and quality of life. Meanwhile investigators are developing novel and molecular targeted therapies in locoregionally advanced or metastatic NPC. This chapter will provide a basic understanding of the clinical data fromrandomized chemotherapy trials in NPC, current effort to integrate neoadjuvant chemotherapy to concurrent chemo-radiation in advanced NPC, and selection of high risk NPC by molecular marker of minimal residual disease for adjuvant therapy. On-going clinical studies in molecular targeted therapies in NPC, including the epidermal growth factor receptor (EGFR), vascular endothelial growth factor (VEGF), epigenetic therapy, Epstein-Barr virus (EBV) directed immunotherapy and gene therapy, will also be discussed.