Management of Metastatic Nasopharyngeal Carcinoma

Abstract Excellent locoregional control can now be achieved in patients with nasopharyngeal cancer (NPC) after chemoradiotherapy delivered by intensity-modulated radiotherapy (IMRT). Distant failure occurs in up to 25%–30% of all patients, and has become the main cause of cancer mortality. As prognosis of patients with metastatic NPC can be variable, assigning patients to different prognostic groups using different prognostic models can facilitate personalized cancer treatment. While gemcitabine-cisplatin doublet emerges as the standard first-line chemotherapy, both nonplatinum and platinum-containing chemotherapy regimens and various targeted therapies can serve as second or later lines of systemic therapy. Apart from standard radiological assessments, Epstein–Barr virus DNA is also an important and unrivalled blood biomarker, which can provide longitudinal monitoring of therapeutic outcome as well as potentially predicting early chemotherapy response. With advent of image-guided high-precision IMRT, there has been a paradigm shift in recent years to offer more ablative local radiotherapy for patients with oligometastasis, and also high dose radiotherapy to the primary tumor in patients with de novo metastasis when appropriate. It is envisaged that intensifying both systemic and local therapy may help confer durable control of the distant, with a view to improving symptom control, quality of life, and even survival.