From the Guidelines
Treatment for nasopharyngeal cancer relapse should be tailored to the individual patient, with options including surgical salvage, re-irradiation, or systemic therapy, depending on the extent and location of the recurrence, as well as the patient's previous treatments and overall health status. When considering treatment options, it is essential to evaluate the volume, location, and extent of the recurrent tumor 1. For small local recurrences, nasopharyngectomy, brachytherapy, radiosurgery, stereotactic RT, IMRT, or a combination of surgery and RT, with or without concurrent chemotherapy, may be considered 1. In cases of regional recurrence, radical neck dissection is recommended if the tumor is resectable 1. For metastatic disease, palliative chemotherapy should be considered for patients with adequate performance status, with platinum combination regimens being commonly used as first-line therapy 1. Key factors influencing treatment selection include the site and extent of recurrence, previous treatments received, time since initial treatment, and the patient's overall health status. Close monitoring during treatment is crucial to manage potential side effects, which may include radiation-induced toxicities, chemotherapy-related adverse events, and other treatment-specific complications. The choice of treatment should prioritize minimizing damage to previously irradiated normal tissues while effectively targeting residual cancer cells. In the context of metastatic NPC, polychemotherapy is more active than monotherapy, and treatment choice should be based on previous treatments and the expected toxicity 1. Ultimately, the goal of treatment is to improve disease-free survival and overall quality of life for patients with nasopharyngeal cancer relapse.
From the Research
Nasopharynx Cancer Relapse Treatment
- The treatment of nasopharyngeal carcinoma (NPC) is challenging due to its distinct anatomic location and biology, with three WHO subtypes considering the presence of Epstein-Barr virus (EBV) and other histopathology features 2.
- Despite the survival benefit obtained from modern treatment modalities and techniques, a number of patients with NPC will recur and subsequently die of distant metastasis, locoregional relapse, or both 2.
- In the recurrent setting, the ideal therapy approach continues to be a topic of discussion, with current recommendations being platinum-based combination chemotherapy 2.
Treatment Options
- Phase III clinical trials that led to the approval of pembrolizumab or nivolumab for head and neck squamous cell carcinoma (HNSCC) specifically excluded NPC, and no immune checkpoint inhibitor therapy has been approved by the FDA to treat NPC 2.
- The National Comprehensive Cancer Network (NCCN) recommendations do include the use of these agents, but this remains a major challenge for treatment options 2.
- Induction chemotherapy followed by concomitant chemoradiation is the standard therapy for patients with locoregionally advanced NPC, with different regimens such as TPF (docetaxel, cisplatin, and 5-fluorouracil) and GP (gemcitabine/cisplatin) being compared in clinical studies 3.
Clinical Studies
- A retrospective cohort study evaluated the long-term complications and prognostic factors in locally advanced NPC treated with TPF induction chemotherapy followed by concurrent chemoradiotherapy, finding that the complete response rate after CCRT was a significant prognostic factor for survival 4.
- A study compared the efficacy and toxicity of TPF and PF (cisplatin and 5-fluorouracil) induction chemotherapy regimens in young and middle-aged patients with locoregionally advanced NPC, finding that TPF achieved a more satisfactory local recurrence-free survival rate with acceptable toxicity 5.
- A phase II study evaluated the therapeutic results of alternating chemoradiotherapy for locally advanced nasopharyngeal cancer using cisplatin and 5-fluorouracil, finding that this method yielded higher or at least similar survival rates and lower toxicities than concurrent chemoradiotherapy 6.