Content area
Full text
Non‐keratinizing nasopharyngeal carcinoma (NPC) is a unique disease in terms of its geographic distribution, biological association with the Epstein–Barr virus (EBV), and its sensitivity to chemotherapy and radiotherapy (RT). Endemic to China and the South‐east Asian region, this cancer reaches a peak incidence rate of around 20 per 100 000 person‐years in Hong Kong,(1) where there has been a substantial improvement in treatment outcome for NPC from 1996 to 2000 as reported in a population‐based analysis by the Hong Kong NPC Study Group.(2) However, this analysis also highlighted the fact that distant recurrence is the most common cause of treatment failure following RT with a reported 5‐year rate of 19% for all disease stages, and 25% for the stage III‐IVB subgroup.(2,3) This trend is likely to bring about an increasing burden of metastatic cases that is largely incurable in the majority of patients. The immediate priorities lie in the identification of effective adjunctive therapies for controlling micrometastases following RT, and prolonging disease remission in patients with recurrent or metastatic NPC. The present review focuses on the recent advances in the clinical development of systemic strategies that may fulfill these priorities. These include the novel applications of cytotoxic chemotherapy, translational studies of molecular targeted agents, and vaccine therapy against EBV‐associated antigens. Table 1 outlines some of the contemporary challenges of treating NPC, and the potential roles that systemic strategies may play in optimizing therapeutic outcome.
Potential systemic strategies for improving the treatment outcome for nasopharyngeal carcinoma (NPC)| Challenges | Potential systemic strategies |
| Distant failure after radiotherapy in stage III‐IVb NPC | – Early identification of patients at risk of distant failure using plasma Epstein–Barr virus DNA |
| – Eradicate micrometastases with adjunctive chemotherapy, or targeted agents | |
| Optimal schedule of adjunctive therapy with radiotherapy unclear | – Evaluate neoadjuvant chemotherapy before chemoradiation |
| – Adjuvant chemotherapy | |
| Improve tolerability of adjunctive therapy with radiotherapy | – Adopt modern cytotoxic agents in adjuvant therapy (e.g. gemcitabine, taxanes) |
| – Replace cisplatin with other radiosensitizers (e.g. oral 5‐fluorouracil, bevacizumab, cetuximab) | |
| – Improve supportive therapy during radiotherapy | |
| – Better radiotherapy techniques | |
| Platinum resistance in a palliative setting | – Using multiple drugs with few cross‐resistance |
| – Use other platinum (e.g. oxaliplatin) | |
| – New non‐platinum agents (e.g. gemcitabine, capecitabine, taxanes) |