What is the primary treatment for nasopharyngeal carcinoma?

From the Guidelines

The primary treatment for nasopharyngeal carcinoma is radiation therapy, often combined with chemotherapy (chemoradiation), with the most recent guidelines suggesting the addition of immunotherapy for advanced and metastatic disease. For early-stage disease (stage I), radiation therapy alone may be sufficient, typically delivered at doses of 66-70 Gy to the primary tumor over 6-7 weeks 1. For more advanced disease (stages II-IVB), concurrent chemoradiation is the standard approach, with cisplatin administered during radiation, and may be followed by adjuvant chemotherapy with cisplatin and 5-fluorouracil for 2-3 cycles in high-risk patients 1.

Key Considerations

• The combination of radiation and chemotherapy is effective because radiation directly damages tumor DNA while chemotherapy both enhances radiation sensitivity and addresses potential micrometastatic disease 1.
• Treatment planning requires careful consideration of nearby critical structures like the brainstem, optic nerves, and parotid glands to minimize long-term toxicity while maintaining therapeutic efficacy 1.
• For advanced and metastatic disease, the addition of immunotherapy (such as camrelizumab or toripalimab) to first-line treatment with cisplatin and gemcitabine may be considered, pending long-term results of overall survival benefit and the assessment of the role of maintenance therapy 1.
• In high-risk locoregionally advanced NPC, the addition of metronomic or standard dose adjuvant capecitabine to chemoradiotherapy (CRT) may be considered, according to the results of two phase III trials that showed improvement of failure-free survival when compared with no adjuvant therapy 1.

Treatment Approach

• Early-stage disease: radiation therapy alone or combined with chemotherapy.
• Advanced disease: concurrent chemoradiation with cisplatin, followed by adjuvant chemotherapy.
• Advanced and metastatic disease: consideration of immunotherapy addition to first-line treatment.
• High-risk locoregionally advanced NPC: consideration of metronomic or standard dose adjuvant capecitabine to CRT.

From the FDA Drug Label

Docetaxel Injection was studied in combination with cisplatin and 5-fluorouracil (TCF) versus cisplatin and 5-fluorouracil (CF) for the induction treatment of nasopharyngeal carcinoma (NPC) in pediatric patients prior to chemoradiation consolidation Seventy-five patients (median age 16 years, range 9 to 21 years) were randomized (2:1) to Docetaxel Injection (75 mg/m2) in combination with cisplatin (75 mg/m2) and 5-fluorouracil (750 mg/m2) (TCF) or to cisplatin (80 mg/m2) and 5-fluorouracil (1000 mg/m2/day) (CF)

The primary treatment for nasopharyngeal carcinoma mentioned in the label is a combination of docetaxel, cisplatin, and 5-fluorouracil (TCF).

• The recommended dose for Docetaxel Injection in combination with cisplatin and 5-fluorouracil is 75 mg/m2.
• This treatment is used for induction prior to chemoradiation consolidation.
• The primary endpoint was the complete response (CR) rate following induction treatment of NPC.
• One patient out of 50 in the TCF group (2%) had a complete response while none of the 25 patients in the CF group had a complete response 2.

From the Research

Diagnosis and Treatment of Nasopharyngeal Carcinoma

• Nasopharyngeal carcinoma (NPC) is a type of cancer that occurs in the nasopharynx, which is the upper part of the throat behind the nose.
• The primary treatment for NPC is radiation therapy (RT) with or without chemotherapy 3.
• Intensity-modulated radiation therapy (IMRT) is a type of RT that uses advanced technology to deliver high doses of radiation to the tumor while sparing surrounding healthy tissues 4, 5, 6.

Early-Stage Nasopharyngeal Carcinoma

• For early-stage NPC, IMRT alone can be an effective treatment, with high survival rates and low toxicity 4, 7.
• A study found that IMRT alone for Stage T1N0, T2N0, T1N1, and T2N1 NPC yielded satisfactory survival outcomes with acceptable toxicity 4.
• Another study reported that the 3-year overall survival, local recurrence-free survival, and distant metastasis-free survival rates for early-stage NPC treated with IMRT with or without chemotherapy were 93.3%, 94.1%, and 94.8%, respectively 7.

Advanced Nasopharyngeal Carcinoma

• For advanced NPC, chemotherapy is often used in combination with RT to improve treatment outcomes 3, 5.
• A study found that the addition of chemotherapy to IMRT improved survival rates for patients with T2N1 NPC 7.
• Another study reported that the estimated 2-year local progression-free, regional progression-free, locoregional progression-free, and distant metastasis-free rates for advanced NPC treated with IMRT and chemotherapy were 92.6%, 90.8%, 89.3%, and 84.7%, respectively 5.

Treatment Outcomes and Toxicity

• IMRT has been shown to reduce toxicity compared to conventional RT, with significantly reduced rates of xerostomia (dry mouth) and other side effects 4, 5, 6.
• A study found that the rate of grade 2 xerostomia at 1 year from start of IMRT was 13.5%, with only two patients complaining of grade 3 xerostomia and none having grade 4 xerostomia 5.
• Another study reported that no grade IV toxicities were observed in patients treated with IMRT with or without chemotherapy for early-stage NPC 7.