Multimodality Management of EBV-Associated Nasopharyngeal Carcinoma

SIMPLE SUMMARY: Nasopharyngeal carcinoma (NPC) is a cancer that arises from the mucosal epithelium of the nasopharynx. NPC is usually detected at a locoregionally advanced stage, resulting in the need for multimodality therapy. This review highlights the existing clinical trials investigating the optimal chemoradiation regimens. A specific focus was made to describe the latest clinical trials regarding the use of induction chemotherapy, which has now emerged as a mainstay of treatment. NPC also has a unique biologic signature that is associated with the Epstein-Barr Virus (EBV). Immunotherapy drug development has centered around exploiting the immune-cell rich tumor microenvironment by instigating the use of immune checkpoint blockage therapies. The close association of NPC with EBV has led to the identification of specific biomarkers that allow for real-time monitoring of disease response and prognostication, resulting in a potential new era of precision and personalized medicine. ABSTRACT: Nasopharyngeal carcinoma (NPC) is a rare cancer of the nasopharyngeal mucosa with a specific geographic predisposition. NPC is often associated with Epstein–Barr Virus (EBV) infection and as a result contains many characteristic biomarkers. Treatment of locally-contained NPC is generally achieved through use of radiotherapy (RT), as part of a multimodality treatment regimen. Induction chemotherapy followed by concurrent RT and platinum-based chemotherapy regimen has emerged as the definitive treatment of choice for locoregionally-advanced NPC. Recently, immunotherapy is finding a role in the treatment of recurrent or metastatic NPC. Immune checkpoint blockade therapies targeted against the programmed death-1 (PD-1) receptor have demonstrated efficacy in early phase clinical trials, with ongoing phase III trials in effect. Biomarkers for treatment efficacy remain an ongoing area of investigation, with important prognostic implications on the horizon.