This protocol addresses patients with nasopharyngeal carcinoma that is either metastatic and not newly diagnosed, or has relapsed locoregionally in a way that cannot be managed with salvage surgery or further radiotherapy. In this setting, systemic therapy becomes the primary treatment modality, and adequate performance status guides eligibility.
For patients with metastatic nasopharyngeal carcinoma, palliative systemic treatment should be considered when performance status is adequate. Locoregional recurrence that cannot be resected or re-irradiated is managed on the same pathway.
In metastatic NPC, palliative ChT should be considered for patients with an adequate PS.
No standard second-line treatment exists. Active agents include paclitaxel, docetaxel, 5-FU, capecitabine, irinotecan, vinorelbine, ifosfamide, doxorubicin, oxaliplatin and cetuximab, which can be used as single agents or in selected combinations [III, B].
Nivolumab, pembrolizumab and camrelizumab have been shown to be safe and active as monotherapy for recurrent and/or metastatic NPC, with ORRs of 20%, 25% and 34%, respectively, with most of the best responses occurring at first radiological evaluation.
DOI: 10.1016/j.annonc.2020.12.007
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