title: Emerging treatment options for nasopharyngeal carcinoma.
abstract: Nasopharyngeal carcinoma is endemic in Asia and is etiologically associated with Epstein-Barr virus. Radiotherapy is the primary treatment modality. The role of systemic therapy has become more prominent. Based on multiple phase III studies and meta-analyses, concurrent cisplatin-based chemoradiotherapy is the current standard of care for locally advanced disease (American Joint Committee on Cancer manual [7th edition] stages II-IVb). The reported failure-free survival rates from phase II trials are encouraging for induction + concurrent chemoradiotherapy. Data from ongoing phase III trials comparing induction + concurrent chemoradiotherapy with concurrent chemoradiotherapy will validate the results of these phase II studies. Intensity-modulated radiotherapy techniques are recommended if the resources are available. Locoregional control exceeding 90% and reduced xerostomia-related toxicities can now be achieved using intensity-modulated radiotherapy, although distant control remains the most pressing research problem. The promising results of targeted therapy and Epstein-Barr virus-specific immunotherapy from early clinical trials should be validated in phase III clinical trials. New technology, more effective and less toxic chemotherapy regimens, and targeted therapy offer new opportunities for treating nasopharyngeal carcinoma.
authors: State Key Laboratory of Oncology in South China, Sun Yat-sen University Cancer Center, Guangzhou, Guangdong, People's Republic of China.
authors: Lu
authors: L
authors: Zhang
authors: Qiu-Yan
authors: QY
authors: Chen
authors: Huai
authors: H
authors: Liu
authors: Lin-Quan
authors: LQ
authors: Tang
authors: Hai-Qiang
authors: HQ
authors: Mai
mesh_terms: D000970:Antineoplastic Agents / Q000009:adverse effects / Q000494:pharmacology / Q000627:therapeutic use; D002277:Carcinoma; D059248:Chemoradiotherapy / Q000379:methods*; D003131:Combined Modality Therapy; D015195:Drug Design; D020031:Epstein-Barr Virus Infections / Q000150:complications* / Q000628:therapy; D006801:Humans; D007167:Immunotherapy / Q000379:methods; D060828:Induction Chemotherapy / Q000379:methods; D058990:Molecular Targeted Therapy; D000077274:Nasopharyngeal Carcinoma; D009303:Nasopharyngeal Neoplasms / Q000517:prevention & control / Q000628:therapy* / Q000821:virology; D050397:Radiotherapy, Intensity-Modulated / Q000379:methods; D015996:Survival Rate
chemical_list: D000970:Antineoplastic Agents
keywords: chemoradiotherapy; immunotherapy; intensity-modulated radiotherapy; molecular targeted agents; nasopharyngeal carcinoma; prognostic markers
references: Int J Radiat Oncol Biol Phys. 2004 May 1;59(1):21-7
references: 15093895
references: Radiat Oncol. 2008 Jan 24;3:4
references: 18218078
references: Lancet Oncol. 2012 Feb;13(2):172-80
references: 22178121
references: J Immunother. 2010 Nov-Dec;33(9):983-90
references: 20948438
references: Int J Radiat Oncol Biol Phys. 2009 Nov 15;75(4):1071-8
references: 19362784
references: Expert Rev Anticancer Ther. 2010 Mar;10(3):365-75
references: 20214518
references: Int J Radiat Oncol Biol Phys. 2011 May 1;80(1):148-53
references: 20605352
references: BMC Cancer. 2012 Feb 15;12:68
references: 22336097
references: Ann Oncol. 2011 Jun;22(6):1280-1287
references: 21317222
references: Int J Radiat Oncol Biol Phys. 1996 Jun 1;35(3):463-9
references: 8655368
references: Int J Radiat Oncol Biol Phys. 2012 Jun 1;83(2):676-83
references: 22024207
references: Eur J Cancer. 2011 Mar;47(5):656-66
references: 21112774
references: Int J Radiat Oncol Biol Phys. 2004 Dec 1;60(5):1440-50
references: 15590175
references: Eur J Cancer. 2007 Jun;43(9):1399-406
references: 17467265
references: Am J Surg. 1990 Oct;160(4):439-42
references: 2221251
references: J Clin Oncol. 2009 Aug 1;27(22):3684-90
references: 19564532
references: Cancer Res. 2012 Mar 1;72(5):1116-25
references: 22282657
references: Int J Radiat Oncol Biol Phys. 2006 Aug 1;65(5):1300-6
references: 16750333
references: Int J Radiat Oncol Biol Phys. 2004 May 1;59(1):11-20
references: 15093894
references: Cancer. 1998 Dec 1;83(11):2270-83
references: 9840526
references: J Virol. 2004 Jan;78(2):768-78
references: 14694109
references: Int J Hematol. 2011 Mar;93(3):281-293
references: 21336546
references: Br J Cancer. 1999 Aug;80(12):1962-7
references: 10471046
references: Radiother Oncol. 2008 May;87(2):204-10
references: 18329742
references: Int J Radiat Oncol Biol Phys. 2006 Nov 15;66(4):1004-10
references: 17145529
references: J Clin Oncol. 2004 Jul 1;22(13):2643-53
references: 15226332
references: J Clin Oncol. 2002 Apr 1;20(7):1845-52
references: 11919243
references: Expert Rev Mol Diagn. 2007 May;7(3):261-8
references: 17489733
references: Jpn J Clin Oncol. 2006 Mar;36(3):132-6
references: 16520357
references: Radiother Oncol. 1995 Jul;36(1):24-31
references: 8525022
references: J Clin Oncol. 1988 Sep;6(9):1401-10
references: 3047335
references: J Clin Oncol. 2000 May;18(10):2040-5
references: 10811668
references: J Gen Virol. 1988 May;69 ( Pt 5):1051-65
references: 2836550
references: Head Neck. 2002 Oct;24(10):940-6
references: 12369073
references: Am J Clin Oncol. 2012 Oct;35(5):474-9
references: 21577086
references: Curr Opin Otolaryngol Head Neck Surg. 2011 Apr;19(2):82-6
references: 21412154
references: Head Neck. 2013 May;35(5):689-94
references: 22715047
references: J Clin Oncol. 2003 Feb 15;21(4):631-7
references: 12586799
references: Radiother Oncol. 2012 Sep;104(3):305-11
references: 22280806
references: N Engl J Med. 2004 Jun 10;350(24):2461-70
references: 15190138
references: Cancer. 2009 Feb 1;115(3):680-8
references: 19117352
references: Oral Oncol. 2012 Oct;48(10):1038-1044
references: 22591726
references: Clin Cancer Res. 2004 Feb 1;10(3):803-21
references: 14871955
references: Blood. 2003 Apr 15;101(8):3150-6
references: 12468425
references: Oral Oncol. 2012 Oct;48(10):964-968
references: 22571922
references: Ann Oncol. 2012 Oct;23 Suppl 7:vii83-5
references: 22997460
references: Cancer. 1988 Mar 15;61(6):1117-24
references: 3342372
references: Radiother Oncol. 2010 Nov;97(2):263-9
references: 20817290
references: Int J Cancer. 2001 Oct 1;94(1):73-80
references: 11668481
references: Lancet Oncol. 2008 Apr;9(4):367-75
references: 18374290
references: Cancer. 2003 Jul 1;98(1):74-80
references: 12833458
references: J Natl Cancer Inst. 2005 Apr 6;97(7):536-9
references: 15812080
references: Int J Radiat Oncol Biol Phys. 2005 Mar 15;61(4):1107-16
references: 15752890
references: J Immunother. 2004 Jul-Aug;27(4):317-27
references: 15235393
references: Int J Radiat Oncol Biol Phys. 2005 Apr 1;61(5):1393-402
references: 15817342
references: Eur Arch Otorhinolaryngol. 2010 Jul;267(7):997-9
references: 20352240
references: Radiother Oncol. 2012 Sep;104(3):331-7
references: 22103978
references: Ann Oncol. 2012 Apr;23(4):997-1005
references: 21821548
references: Int J Radiat Oncol Biol Phys. 2001 Aug 1;50(5):1181-9
references: 11483327
references: Oncology (Williston Park). 2000 Oct;14(10 Suppl 9):13-8
references: 11098484
references: J Natl Cancer Inst. 2002 Nov 6;94(21):1614-9
references: 12419787
references: Oral Oncol. 2012 Oct;48(10):1007-1013
references: 22525607
references: Head Neck Oncol. 2009 May 23;1:13
references: 19463191
references: Int J Radiat Oncol Biol Phys. 2012 Jan 1;82(1):327-33
references: 21035959
references: BMC Cancer. 2010 Oct 15;10:558
references: 20950416
references: Cancer Res. 2004 Feb 15;64(4):1483-9
references: 14973049
references: Ann Surg Oncol. 2012 Mar;19(3):1001-8
references: 21913020
references: Radiother Oncol. 2009 Dec;93(3):530-3
references: 19853315
references: Ann Surg Oncol. 2011 Jan;18(1):233-8
references: 20737217
references: Cancer. 2001 Dec 1;92(11):2845-55
references: 11753958
references: J Clin Oncol. 2005 May 20;23(15):3568-76
references: 15809453
references: Int J Radiat Oncol Biol Phys. 2010 Aug 1;77(5):1397-402
references: 20044215
references: J Nucl Med. 2007 Oct;48(10):1614-9
references: 17873135
references: Radiother Oncol. 2012 Sep;104(3):272-8
references: 22938727
references: Chin J Cancer. 2010 May;29(5):517-26
references: 20426903
references: Int J Radiat Oncol Biol Phys. 2006 Feb 1;64(2):374-81
references: 16213105
references: Oral Oncol. 2012 Oct;48(10):1045-1050
references: 22633108
references: Cancer. 2002 Apr 15;94(8):2217-23
references: 12001120
references: Int J Radiat Oncol Biol Phys. 2011 Apr 1;79(5):1414-20
references: 20605357
references: Int J Radiat Oncol Biol Phys. 2004 Sep 1;60(1):156-64
references: 15337551
references: J Clin Oncol. 2005 Nov 20;23(33):8461-8
references: 16230677
references: J Clin Oncol. 1998 Apr;16(4):1310-7
references: 9552031
references: Ann Oncol. 2012 May;23(5):1287-1292
references: 21948811
references: J Clin Neuromuscul Dis. 2011 Mar;12(3):147-52
references: 21321494
references: Int J Radiat Oncol Biol Phys. 1995 Oct 15;33(3):569-77
references: 7558945
references: Laryngoscope. 2000 Dec;110(12):2066-9
references: 11129022
references: J Clin Oncol. 2006 Dec 1;24(34):5414-8
references: 17135642
references: Int J Radiat Oncol Biol Phys. 2011 Jul 1;80(3):661-8
references: 20643517
references: J Clin Oncol. 2007 Nov 1;25(31):4873-9
references: 17971582
references: J Clin Oncol. 2009 Jan 10;27(2):242-9
references: 19064973
references: Int J Radiat Oncol Biol Phys. 2003 Jun 1;56(2):413-26
references: 12738316
references: Expert Rev Anticancer Ther. 2010 Sep;10(9):1439-50
references: 20836679
references: Lancet Oncol. 2012 Feb;13(2):163-71
references: 22154591
references: BMC Cancer. 2006 Oct 31;6:259
references: 17076893
references: Otolaryngol Clin North Am. 2011 Oct;44(5):1141-54
references: 21978898
references: Cancer. 2011 May 1;117(9):1874-83
references: 21509764
references: Cancer Sci. 2008 Jul;99(7):1311-8
references: 18498420
references: Otolaryngol Head Neck Surg. 2005 Feb;132(2):303-8
references: 15692545
references: Int J Radiat Oncol Biol Phys. 2013 Mar 15;85(4):929-34
references: 22975606
references: Int J Radiat Oncol Biol Phys. 2011 Jul 1;80(3):655-60
references: 21621119
references: Eur J Cancer. 2009 May;45(7):1107-1110
references: 19327985
references: Semin Radiat Oncol. 2012 Jul;22(3):233-44
references: 22687948
references: Int J Radiat Oncol Biol Phys. 2008 Oct 1;72(2):589-96
references: 18793962
references: Cancer. 2003 Jul 15;98(2):288-91
references: 12872347
references: Int J Radiat Oncol Biol Phys. 2000 May 1;47(2):405-12
references: 10802367
references: Radiother Oncol. 2012 Sep;104(3):294-9
references: 22998947
references: Int J Radiat Oncol Biol Phys. 2002 May 1;53(1):75-85
references: 12007944
references: Head Neck. 2005 Jul;27(7):555-65
references: 15880410
references: Int J Radiat Oncol Biol Phys. 2010 Jan 1;76(1):138-45
references: 19646824
references: Int J Radiat Oncol Biol Phys. 2006 Jan 1;64(1):57-62
references: 15936155
references: Int J Radiat Oncol Biol Phys. 2008 Aug 1;71(5):1356-64
references: 18472356
references: Int J Radiat Oncol Biol Phys. 2006 Jan 1;64(1):47-56
references: 16377415
references: J Natl Cancer Inst. 2010 Aug 4;102(15):1188-98
references: 20634482
references: J Clin Oncol. 2005 Dec 10;23(35):8942-9
references: 16204009
references: Head Neck. 2011 Jul;33(7):969-75
references: 20967865
references: J Virol. 1992 May;66(5):2689-97
references: 1313894
references: Ann Oncol. 2004 Jan;15(1):113-7
references: 14679129
references: Blood. 2005 Mar 1;105(5):1898-904
references: 15542583
references: Cancer. 1999 Nov 15;86(10):1912-20
references: 10570413
references: Laryngoscope. 1999 May;109(5):810-4
references: 10334236
references: Cancer Chemother Pharmacol. 2008 Jun;62(1):59-64
references: 17762933
references: Eur J Radiol. 2013 Feb;82(2):366-73
references: 23083522
references: Radiother Oncol. 2011 Jan;98(1):15-22
references: 20971520
references: Head Neck. 2012 May;34(5):753-7
references: 22488786
references: Ann Oncol. 2012 Feb;23(2):427-35
references: 21525406
references: Int J Radiat Oncol Biol Phys. 2011 Feb 1;79(2):420-8
references: 20452132
references: Cancer Treat Rev. 2007 Oct;33(6):499-505
references: 17544585
references: Laryngoscope. 2009 Mar;119(3):516-22
references: 19235750
references: Int J Radiat Oncol Biol Phys. 2009 Dec 1;75(5):1481-6
references: 19386431
references: Int J Radiat Oncol Biol Phys. 2009 Jul 15;74(4):1070-6
references: 19231110
references: Cancer. 2008 Sep 15;113(6):1332-7
references: 18615622
references: Int J Radiat Oncol Biol Phys. 2009 Mar 15;73(4):1121-8
references: 18723296
references: J Clin Oncol. 2001 Mar 1;19(5):1350-7
references: 11230478
references: Eur J Cancer. 2012 Dec;48(18):3422-8
references: 22835782
references: J Clin Oncol. 2005 Sep 20;23(27):6730-8
references: 16170180
references: Int J Radiat Oncol Biol Phys. 2006 Nov 15;66(4):981-91
references: 17145528
references: Head Neck. 2008 Jul;30(7):863-7
references: 18213730
references: J Natl Cancer Inst. 2011 Dec 7;103(23):1761-70
references: 22056739
references: Int J Radiat Oncol Biol Phys. 2002 May 1;53(1):12-22
references: 12007936
references: Int J Radiat Oncol Biol Phys. 2005 Jul 1;62(3):672-9
references: 15936544