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Locoregionally advanced nasopharyngeal carcinoma is nasopharyngeal cancer, the Epstein-Barr-virus-driven cancer behind the nose, that has grown into nearby structures or neck lymph nodes but not further. It is treated without surgery, by precise radiotherapy with cisplatin, usually after gemcitabine and cisplatin chemotherapy and in recent trials with PD-1 immunotherapy; most patients are cured.
Nasopharyngeal carcinoma in its endemic form is a non-keratinising carcinoma driven by Epstein-Barr virus, concentrated in southern China, South East Asia, North Africa and the Arctic, and it presents late because the nasopharynx is silent: a neck mass, unilateral hearing loss or blood-stained nasal discharge are the usual first signs, and by then most tumours have reached the skull base or the neck nodes. Plasma EBV DNA is a tumour marker that screens populations (a Hong Kong trial detected early tumours in asymptomatic men), stages the disease and, when still detectable after radiotherapy, identifies patients at high risk of relapse. The tumour is exquisitely sensitive to radiotherapy and chemotherapy, so surgery has no role in primary treatment.
The Intergroup 0099 trial (1998) established concurrent cisplatin chemoradiotherapy over radiotherapy alone, and intensity-modulated radiotherapy, which spares the parotids, brainstem and optic pathways around this awkward target, became standard in the 2000s. Induction chemotherapy was then shown to add benefit: the Sun Yat-sen phase 3 trial of gemcitabine and cisplatin before chemoradiotherapy (New England Journal of Medicine 2019) improved three-year recurrence-free survival from 76.5 to 85.3 percent and overall survival, and docetaxel-cisplatin-fluorouracil (TPF) induction had shown a similar effect, so induction gemcitabine-cisplatin followed by cisplatin chemoradiotherapy is the CSCO-ASCO and NCCN standard for stage III to IVA disease. Metronomic capecitabine for a year after chemoradiotherapy improved failure-free survival in a further Chinese phase 3 (Lancet 2021), and adjuvant therapy directed by post-treatment plasma EBV DNA is being tested in NRG-HN001. PD-1 antibodies have entered the curative setting: the CONTINUUM trial (Lancet 2024) added sintilimab to induction chemotherapy and chemoradiotherapy and improved three-year event-free survival from 76 to 86 percent, and trials of toripalimab and camrelizumab in the same setting are reporting. De-escalation is the other direction: trials omit concurrent cisplatin in low-risk stage II to III patients after induction, reduce radiotherapy dose in good responders and use proton therapy to cut late toxicity, because survivors live for decades with xerostomia, hearing loss, cranial neuropathy and the risk of carotid disease.
About two thirds of nasopharyngeal carcinoma in endemic southern China and South East Asia presents at stage III or IVA because the tumour site is hidden; it is curable in most patients with chemoradiotherapy.
Site decides cause and behaviour: HPV drives oropharyngeal cancer, EBV drives nasopharyngeal cancer, tobacco drives oral and laryngeal cancer; all drain into the neck node levels that surgeons and radiotherapists map.
Same organ: Acinic cell carcinoma of the salivary glands, Carcinoma ex pleomorphic adenoma, Multiple endocrine neoplasia type 1 (MEN1), Multiple endocrine neoplasia type 2 (MEN2A and MEN2B), Hyperparathyroidism-jaw tumour syndrome (CDC73-related parathyroid carcinoma), Oropharyngeal cancer (tonsil and base of tongue), Laryngeal and hypopharyngeal cancer, Oral cavity cancer (mouth and tongue), Head and neck squamous cell carcinoma, Nasopharyngeal carcinoma, Salivary gland cancers, Papillary thyroid cancer, Follicular thyroid cancer, Medullary thyroid cancer, Anaplastic thyroid cancer, Thyroid cancer, Nasal cavity and paranasal sinus cancers (including esthesioneuroblastoma), NUT carcinoma (midline carcinoma with NUTM1 rearrangement), Parathyroid carcinoma, Multiple endocrine neoplasia syndromes (MEN1, MEN2, MEN4), HPV-positive oropharyngeal cancer, HPV-negative head and neck squamous cell carcinoma (including HPV-negative oropharyngeal cancer), Recurrent or metastatic head and neck squamous cell carcinoma, Hypopharyngeal cancer, Adenoid cystic carcinoma, Salivary duct carcinoma, Mucoepidermoid carcinoma, Oral tongue and floor of mouth cancer, Buccal mucosa and gingivobuccal cancer (oral cancer in India), Lip cancer, Recurrent and metastatic nasopharyngeal carcinoma, Esthesioneuroblastoma (olfactory neuroblastoma), Sinonasal undifferentiated carcinoma (SNUC) and SWI/SNF-deficient sinonasal carcinoma
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Also on OnCo: Symptoms and red flags · Early detection roadmap.
MRI of the nasopharynx and neck, PET-CT or CT of chest and abdomen with bone scan, plasma EBV DNA, dental and audiological assessment.
Induction gemcitabine and cisplatin for three cycles followed by intensity-modulated radiotherapy (70 Gy) with concurrent cisplatin; TPF induction as an alternative.
Metronomic capecitabine for one year in high-risk patients; EBV DNA-directed adjuvant therapy in trials (NRG-HN001).
PD-1 antibody (sintilimab in CONTINUUM; toripalimab and camrelizumab in trials) added to induction and chemoradiotherapy in high-risk disease, adopted in China.
Plasma EBV DNA, MRI and nasopharyngoscopy; management of xerostomia, hearing loss, hypothyroidism and hypopituitarism.
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PD-1 blockade added to chemoradiotherapy is a new option for high-risk locoregionally advanced nasopharyngeal carcinoma; longer follow-up will show whether it lengthens survival.
The standard-of-care rows on the locoregionally advanced nasopharyngeal page follow this guideline.
Induction gemcitabine and cisplatin followed by chemoradiotherapy is the standard for locoregionally advanced nasopharyngeal carcinoma in endemic regions and in guidelines internationally.
Concurrent cisplatin with radiotherapy is the foundation of treatment for locoregionally advanced nasopharyngeal carcinoma; later trials in endemic regions refined the role of induction and adjuvant chemotherapy.
Query for this cancer: (TITLE:"Locoregionally advanced nasopharyngeal carcinoma" OR ABSTRACT:"Locoregionally advanced nasopharyngeal carcinoma" OR TITLE:"stage III to IVA" OR ABSTRACT:"stage III to IVA" OR TITLE:"Locally advanced NPC" OR ABSTRACT:"Locally advanced NPC" OR TITLE:"Stage III to IVA nasopharyngeal carcinoma" OR ABSTRACT:"Stage III to IVA nasopharyngeal carcinoma" OR TITLE:"Non-metastatic advanced nasopharyngeal carcinoma" OR ABSTRACT:"Non-metastatic advanced nasopharyngeal carcinoma" OR TITLE:"Endemic EBV-associated nasopharyngeal carcinoma, locoregionally advanced" OR ABSTRACT:"Endemic EBV-associated nasopharyngeal carcinoma, locoregionally advanced") AND (treatment OR therapy OR trial OR survival OR diagnosis). Results are unfiltered search hits about Locoregionally advanced nasopharyngeal carcinoma (stage III to IVA), not a curated reading list.
The targets of this cancer's medicines and the ones linked to it directly.
Cases by country, the UK and NHS pathway and other country lenses, the expert centres with trials on record, and the centres named on this cancer's subtypes.
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Bleeding that does not stop by itself, bleeding from more than one site, or new bruising in several places or one large area.
Persistent headache with extreme tiredness, nausea, dizziness on standing or low blood pressure. Vomiting, severe weakness or collapse is adrenal crisis.
Dose reduce or avoid for CrCl below 60 (carboplatin is the alternative).
Immune-related adverse events (irAEs) are the autoimmune side effects of checkpoint inhibitors: colitis, thyroid problems, rash, hepatitis, pneumonitis.
The bowel cancer regimens share low blood counts, tiredness, sickness and a sore mouth. Oxaliplatin adds cold-triggered tingling, irinotecan adds early and late diarrhoea, capecitabine adds hand-foot syndrome and needs a DPD test first, and cetuximab or panitumumab add an acne-like rash and low magnesium. The rule for all of them: ring the 24-hour number rather than wait.
The leukaemia risk after chemotherapy was described in the era of mustards and etoposide, and it did not stay there. Platinum drugs carry it, PARP inhibitors raise it about two and a half times against placebo, and lenalidomide with oral melphalan raises it nearly fivefold against melphalan alone. The absolute numbers are small, but the choice of partner drug is sometimes a real decision.
See all on the product pages:CamrelizumabCapecitabineCisplatinGemcitabine + cisplatinToripalimab·Printable cards in the navigator
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