From Evidence to Practice: Integrating Toripalimab into Frontline Care for Recurrent Locally Advanced or Metastatic Nasopharyngeal Carcinoma - Episode 1
Panelists discuss the distinct Epstein-Barr virus (EBV)-driven biology of nasopharyngeal carcinoma (NPC), the role of plasma EBV DNA as a biomarker, and the strong evidence supporting gemcitabine-based induction chemotherapy followed by chemoradiotherapy as standard treatment for locally advanced disease.
The discussion opened with an overview of nasopharyngeal carcinoma (NPC)NPC, emphasizing its distinct biology compared to with other head and neck cancers. Unlike typical mucosal carcinomas often driven by tobacco, alcohol, or HPVhuman papillomavirus, NPC is closely associated with Epstein-Barr virus (EBV)EBV, which plays a central role in tumorigenesis. This viral link not only influences disease biology but also affects treatment strategies and monitoring, making EBV a critical biomarker for diagnosis, prognosis, and response assessment.
In terms of treatment, early-stage NPC is commonly managed with chemoradiotherapy, which remains the standard approach for local control. For more advanced stages—such as T4 disease or those with extensive nodal involvement—induction chemotherapy followed by concurrent chemoradiotherapy has demonstrated superior outcomes. Regimens like such as gemcitabine plus cisplatin are particularly effective, with tumors showing high sensitivity to this combination. Unlike other head and neck cancers where for whichTPF docetaxel, cisplatin and fluorouracil combination regimens are preferred, EBV-positive NPC responds better to gemcitabine-based induction, offering deeper and more durable responses.
The panel also highlighted the importance of accurate staging using MRI and PET scans, given the higher likelihood of silent distant metastases in NPC. Quantifying EBV DNA in plasma is a powerful tool not only for diagnosis but also for predicting treatment outcomes and tracking disease post-therapy. The presence of high EBV DNA levels at diagnosis or after treatment correlates with a poorer prognosis. The consensus was clear that induction chemotherapy should be used for most patients with stage III or IV disease, unless contraindicated. Even if patients treatment begin with chemoradiation alone, efforts should be made to incorporate additional systemic therapy, as evidence consistently shows improved survival with more intensive regimens. However, challenges such as post-radiation toxicity and hydration requirements for cisplatin must be considered in treatment planning.