In this E-Learning module, the author elaborates on the epidemiology of nasopharyngeal carcinoma, the geographical distribution, the histological classification, characteristics of endemic and non-endemic forms, pathogenesis, patterns of distant recurrence, prognostic factors in metastatic disease, prognosis by stage, staging classification, patient selection and biomarkers, the use of chemotherapy, targeted therapy and immunotherapy, management of oligometastasis and de novo metastatic disease.
Among the clinical considerations, when individualising systemic therapy for patients with metastatic nasopharyngeal carcinoma, the author elaborates on the patient and disease-related factors, specific investigations before starting systemic therapy, the utility of plasma Epstein-Barr Virus (EBV) DNA for management, general principles of sequencing systemic treatment, general management flow in first-line and subsequent line therapy.
The author goes on stating that chemotherapy is the mainstay of metastatic treatment and provides an overview of the results from the clinical trials in terms of efficacy and toxicity, including the findings from maintenance chemotherapy.
In the following chapter, the author elaborates on the mutational landscape from the whole exome and whole genome sequencing studies of nasopharyngeal carcinoma, as well as presenting the key results in terms of use of targeting anti-vascular multikinase tyrosine kinase inhibitors, targeting angiogenesis with monoclonal antibodies, other selected targeted therapies, and antibody drug conjugates.
In terms of immunotherapy, the author discusses the targeting tumour microenvironment, immunotherapeutic strategies for non-EBV and EBV targeting, and provides an overview of the results from the clinical trials with PD1/PD-L1 inhibitors in different settings. In terms of biomarkers, the author elaborates on PD-L1 expression and gene expression profiling of the tumour microenvironment. The author also discusses the combination therapies with immunotherapy, as well as cell therapies. The part of the module related to the management is supported by algorithms from different international clinical practice guidelines.
The last part of the module is devoted to the definition and management of the oligometastatic disease, as well as the efficacy and safety of locoregional radiotherapy with chemotherapy versus chemotherapy alone in de novo metastatic nasopharyngeal carcinoma.
