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10 slides generated from the cancer page, with a quiz from the open benchmark and speaker notes that cite the sources. Arrow keys move between slides; Print gives one slide per page.
A cancer at the back of the nose caused largely by the Epstein-Barr virus and common in southern China and Southeast Asia. Radiation cures most early cases; adding chemotherapy and, recently, PD-1 immunotherapy has improved outcomes in advanced disease, and a blood test for viral DNA can detect it early.
Nasopharyngeal carcinoma (NPC) in endemic regions is EBV-associated non-keratinising carcinoma with distinct biology (NF-κB pathway alterations, immune-rich stroma, low TMB), while sporadic Western cases include keratinising HPV- or smoking-related tumours. Plasma EBV DNA is a diagnostic, prognostic and surveillance marker, and population screening with EBV DNA detected early-stage cancers in Hong Kong (Chan, NEJM 2017).
IMRT is the backbone: radiotherapy alone for stage I, concurrent cisplatin-radiotherapy for stage II-IVA (Intergroup 0099), with induction gemcitabine-cisplatin improving survival in locoregionally advanced disease (Zhang, NEJM 2019) and adjuvant metronomic capecitabine adding benefit in high-risk patients (Chen, Lancet 2021). Recurrent or metastatic disease is treated with gemcitabine-cisplatin plus a PD-1 inhibitor: toripalimab (JUPITER-02; FDA approval 2023, the first US approval for NPC), camrelizumab (CAPTAIN-1st), tislelizumab (RATIONALE-309) and penpulimab (FDA 2025). Nasopharyngectomy (endoscopic) and re-irradiation are options for local recurrence. Late toxicities of radiotherapy (xerostomia, hearing loss, temporal-lobe necrosis, carotid stenosis) drive de-escalation trials guided by EBV DNA.
| Setting | Approach | Guideline |
|---|---|---|
| Stage I | IMRT alone (70 Gy) to nasopharynx and elective neck. | NCCN Category 2A |
| Stage II-IVA | Induction gemcitabine-cisplatin ×3 then concurrent cisplatin-IMRT (for stage III-IVA); concurrent chemoradiation alone for stage II; adjuvant capecitabine for high-risk (detectable post-RT EBV DNA, N2-3). | NCCN Category 1 (induction GP), ESMO-MCBS A |
| Recurrent/metastatic, first line | Gemcitabine-cisplatin + PD-1 inhibitor (toripalimab, camrelizumab, tislelizumab or penpulimab), then PD-1 maintenance. | NCCN Category 1 (toripalimab + GP), ESMO-MCBS 4 |
| Local recurrence | Endoscopic or open nasopharyngectomy for resectable rT1-3 (better survival than re-irradiation, Liu Lancet Oncol 2021); hyperfractionated re-IMRT otherwise. | not mapped |