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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.
Recurrent or metastatic nasopharyngeal carcinoma is nasopharyngeal cancer that has come back after radiotherapy or spread to the bones, liver or lungs. Gemcitabine with cisplatin is the chemotherapy backbone, adding a PD-1 antibody such as toripalimab in JUPITER-02 and later trials lengthened survival and became standard, and local recurrence is treated with endoscopic surgery or re-irradiation.
Nasopharyngeal carcinoma recurs in two ways that are treated differently. Local or regional recurrence after radiotherapy, in the nasopharynx or neck, is potentially curable: endoscopic nasopharyngectomy, shown in a Chinese randomised trial (Lancet Oncology 2021) to give better survival and fewer complications than re-irradiation for resectable recurrence, neck dissection for nodal relapse, and hyperfractionated intensity-modulated re-irradiation, which in a further randomised trial (Lancet 2023) reduced the severe late toxicity of a second course of radiotherapy. Distant metastases, most often to bone, liver and lung, are incurable in most patients, although a minority with oligometastatic disease gain from locoregional radiotherapy of the primary added to chemotherapy, as a Chinese phase 3 (JAMA Oncology 2020) showed.
Systemic therapy for metastatic disease was standardised by the GEM20110714 trial (Lancet 2016), in which gemcitabine and cisplatin beat fluorouracil and cisplatin on progression-free survival (7.0 against 5.6 months) and overall survival. Because EBV-driven tumours are inflamed and PD-L1-rich, PD-1 antibodies were tested next, almost entirely by Chinese companies and investigators: JUPITER-02 (Nature Medicine 2021, JAMA 2023) added toripalimab to gemcitabine-cisplatin in 289 patients and lengthened progression-free survival from 8.0 to 11.7 months with a survival benefit, leading to approval in China in 2021 and in the United States in October 2023, the first approval of a Chinese-developed PD-1 antibody there and the first drug approved for nasopharyngeal carcinoma; CAPTAIN-1st (camrelizumab, Lancet Oncology 2021) and RATIONALE-309 (tislelizumab) showed the same pattern, and penpulimab with gemcitabine-cisplatin was approved in the United States in April 2025. PD-1 antibodies alone are used after platinum failure (nivolumab, pembrolizumab, camrelizumab and toripalimab all have phase 2 data), and later lines include gemcitabine-based or taxane-based chemotherapy, capecitabine and the anti-EGFR antibody nimotuzumab in China. The pipeline is dominated by antibody-drug conjugates, notably the EGFR-directed MRG003 and the EGFR-HER3 bispecific BL-B01D1 and the B7-H3-directed YL201, in phase 3 against chemotherapy, and by EBV-specific T-cell therapies, which have produced durable responses in small trials. Plasma EBV DNA tracks response, and locoregional radiotherapy for de novo metastatic disease with a good chemotherapy response is now guideline-endorsed.
| Setting | Approach | Guideline |
|---|---|---|
| Resectable local recurrence | Endoscopic nasopharyngectomy (better survival and fewer complications than re-irradiation in a randomised trial); neck dissection for nodal recurrence. | not mapped |
| Unresectable local recurrence | Hyperfractionated intensity-modulated re-irradiation or proton therapy with careful dose constraints; systemic therapy where re-irradiation is unsafe. | not mapped |
| Metastatic disease, first line | Gemcitabine and cisplatin with a PD-1 antibody (toripalimab, JUPITER-02; camrelizumab, CAPTAIN-1st; tislelizumab; penpulimab), then PD-1 maintenance; locoregional radiotherapy to the primary in patients with a good response. | not mapped |
| After platinum and PD-1 therapy | Gemcitabine, taxane or capecitabine-based chemotherapy; nivolumab or pembrolizumab if no prior PD-1 antibody; trials of antibody-drug conjugates (MRG003, BL-B01D1, YL201) and EBV-specific T cells. | not mapped |
| Oligometastatic disease | Stereotactic radiotherapy or resection of limited metastases with systemic therapy. | not mapped |