# Nasopharyngeal carcinoma

Source: https://onco.cc/cancers/nasopharyngeal/  
OnCo record `nasopharyngeal` (Cancer). Data CC BY-NC 4.0, attribute "Data from OnCo (onco.cc)"; commercial use needs a licence.

## TL;DR

A cancer at the back of the nose caused largely by the Epstein-Barr virus and common in southern China and Southeast Asia. Radiation cures most early cases; adding chemotherapy and, recently, PD-1 immunotherapy has improved outcomes in advanced disease, and a blood test for viral DNA can detect it early.

## Summary

Nasopharyngeal carcinoma (NPC) in endemic regions is EBV-associated non-keratinising carcinoma with distinct biology (NF-κB pathway alterations, immune-rich stroma, low TMB), while sporadic Western cases include keratinising HPV- or smoking-related tumours. Plasma EBV DNA is a diagnostic, prognostic and surveillance marker, and population screening with EBV DNA detected early-stage cancers in Hong Kong (Chan, NEJM 2017).

IMRT is the backbone: radiotherapy alone for stage I, concurrent cisplatin-radiotherapy for stage II-IVA (Intergroup 0099), with induction gemcitabine-cisplatin improving survival in locoregionally advanced disease (Zhang, NEJM 2019) and adjuvant metronomic capecitabine adding benefit in high-risk patients (Chen, Lancet 2021). Recurrent or metastatic disease is treated with gemcitabine-cisplatin plus a PD-1 inhibitor: toripalimab (JUPITER-02; FDA approval 2023, the first US approval for NPC), camrelizumab (CAPTAIN-1st), tislelizumab (RATIONALE-309) and penpulimab (FDA 2025). Nasopharyngectomy (endoscopic) and re-irradiation are options for local recurrence. Late toxicities of radiotherapy (xerostomia, hearing loss, temporal-lobe necrosis, carotid stenosis) drive de-escalation trials guided by EBV DNA.

## Fields

- Kind: Cancer
- Last checked: 2026-09-08
- Also known as: NPC
- Tags: gap-fill; head-and-neck; viral
- Group: head and neck
- Burden: About 120,000 cases per year worldwide, ~70% in East and Southeast Asia (Guangdong incidence 20-30 per 100,000 versus <1 in the West); strongly linked to Epstein-Barr virus.
- Subtypes: Non-keratinising undifferentiated (EBV-associated, endemic; WHO type III); Non-keratinising differentiated (type II); Keratinising squamous (type I; sporadic, smoking); HPV-associated NPC (non-endemic, oropharynx-like)
- Biomarkers: Plasma EBV DNA (screening, staging, post-treatment risk); EBER in situ hybridisation on biopsy; TNM (AJCC 8th) stage; PD-L1 (not required for PD-1 therapy); Post-radiotherapy detectable EBV DNA (adjuvant therapy selection); Family history / HLA (risk)

## Sections of this record

The page is a hub with ten sections in reading order; large sections have their own page. The same plan as JSON: https://onco.cc/api/v1/cancers/nasopharyngeal/sections.json

- Overview (on the hub): The TL;DR, the family this cancer belongs to, the organ, who gets it and what the state of the art is. https://onco.cc/cancers/nasopharyngeal/#overview [2 subtypes, 4 state-of-the-art points]
- What it is (on the hub): Anatomy, the subtypes and how they differ, how it is staged, and where advanced disease spreads. https://onco.cc/cancers/nasopharyngeal/#what-it-is [6 subtypes]
- Finding it (on the hub): How it shows itself, how it is confirmed, what screening exists, and the biomarkers clinicians test for. https://onco.cc/cancers/nasopharyngeal/#finding-it [6 biomarkers]
- Treating it (on the hub): The standard of care by setting, the medicines, surgery and radiotherapy named in it, and the regimens behind them. https://onco.cc/cancers/nasopharyngeal/#treating-it [4 settings, 2 regimens, 3 decisions with options]
- Evidence (on the hub): Trials recruiting now, the landmark trials, the key papers and what they mean, the latest literature, and the milestones year by year. https://onco.cc/cancers/nasopharyngeal/#evidence [16 trials, 2 key papers, 9 milestones]
- The science (on the hub): The molecular landscape: the targets and how often each appears, the pathways, the mechanics stages and the preclinical models. https://onco.cc/cancers/nasopharyngeal/#science [28 targets, 2 pathways]
- Where you are (own page): Cases by country, the UK and NHS pathway and other country lenses, and the expert centres with trials on record. https://onco.cc/cancers/nasopharyngeal/where-you-are/ [1 centre]
- Living with it (on the hub): The decisions you may face, the aids that walk through them, the warnings on record, the first sixty days and the questions to ask. https://onco.cc/cancers/nasopharyngeal/#living-with-it [15 questions, 4 red cards]
- What is coming (own page): Everything in development, the open problems and what is being done about them, the roadmaps, and what changed on this record. https://onco.cc/cancers/nasopharyngeal/coming/ [15 medicines, 16 trials, 4 open problems]
- Data (own page): Every connected record, the notes, the JSON, Markdown and RDF twins, and where the record came from and when it was checked. https://onco.cc/cancers/nasopharyngeal/data/ [98 connected records]

## Standard of care

- Stage I: IMRT alone (70 Gy) to nasopharynx and elective neck. ([IMRT / IGRT (modern external beam)](https://onco.cc/technologies/imrt-igrt/))
- Stage II-IVA: Induction gemcitabine-cisplatin ×3 then concurrent cisplatin-IMRT (for stage III-IVA); concurrent chemoradiation alone for stage II; adjuvant capecitabine for high-risk (detectable post-RT EBV DNA, N2-3). ([Gemcitabine + cisplatin](https://onco.cc/drugs/gemcitabine-cisplatin/), [Cisplatin](https://onco.cc/drugs/cisplatin/), [IMRT / IGRT (modern external beam)](https://onco.cc/technologies/imrt-igrt/))
- Recurrent/metastatic, first line: Gemcitabine-cisplatin + PD-1 inhibitor (toripalimab, camrelizumab, tislelizumab or penpulimab), then PD-1 maintenance. ([Toripalimab](https://onco.cc/drugs/toripalimab/), [Camrelizumab](https://onco.cc/drugs/camrelizumab/), [Tislelizumab](https://onco.cc/drugs/tislelizumab/), [Penpulimab](https://onco.cc/drugs/penpulimab/), [Gemcitabine + cisplatin](https://onco.cc/drugs/gemcitabine-cisplatin/))
- Local recurrence: Endoscopic or open nasopharyngectomy for resectable rT1-3 (better survival than re-irradiation, Liu Lancet Oncol 2021); hyperfractionated re-IMRT otherwise. ([IMRT / IGRT (modern external beam)](https://onco.cc/technologies/imrt-igrt/), [Transoral robotic surgery (TORS)](https://onco.cc/technologies/tors/))

## State of the art

- Plasma EBV DNA is the most mature liquid biopsy in oncology: it screens, stages, guides adjuvant therapy and detects relapse.
- PD-1 inhibitors with GP chemotherapy roughly doubled PFS in metastatic disease; toripalimab was the first FDA approval for NPC and among the first for a Chinese-developed PD-1 antibody.
- Induction GP and adjuvant capecitabine are the standard for locoregionally advanced disease.
- De-escalation (omitting concurrent cisplatin in low-risk stage II, reducing neck irradiation) is being validated in trials led from Guangzhou.

## Open problems

- Radiation late effects in a disease cured young.
- Western access to PD-1 inhibitors studied in Asia; regulatory lag.
- EBV-targeted therapy (vaccines, EBV-specific T cells) still investigational.
- Distant metastasis is the main way treatment fails after chemoradiation; plasma EBV DNA now identifies who needs more.

## Sources

- Wikipedia: https://en.wikipedia.org/wiki/Nasopharyngeal_carcinoma
- CSCO/ASCO NPC guideline (JCO 2021): https://doi.org/10.1200/JCO.20.03237
- EBV DNA screening (NEJM 2017): https://doi.org/10.1056/NEJMoa1701717
- NCI PDQ: nasopharyngeal cancer: https://www.cancer.gov/types/head-and-neck/patient/adult/nasopharyngeal-treatment-pdq

## Connected records

- technologies: [Acupuncture for dry mouth after head and neck radiotherapy](https://onco.cc/technologies/acupuncture-xerostomia/), [Immune checkpoint inhibitors](https://onco.cc/technologies/checkpoint-inhibitor/), [IMRT / IGRT (modern external beam)](https://onco.cc/technologies/imrt-igrt/), [Liquid biopsy (ctDNA)](https://onco.cc/technologies/liquid-biopsy/), [Platinum agents](https://onco.cc/technologies/platinum/), [Proton therapy](https://onco.cc/technologies/proton-therapy/), [TCR-T cell therapy](https://onco.cc/technologies/tcr-t/), [Transoral robotic surgery (TORS)](https://onco.cc/technologies/tors/), [Virus-specific T cells](https://onco.cc/technologies/virus-specific-t-cells/)
- targets: [ARID2](https://onco.cc/targets/arid2/), [CASP8](https://onco.cc/targets/casp8/), [CNTRL](https://onco.cc/targets/cntrl/), [CYLD](https://onco.cc/targets/cyld/), [DSP](https://onco.cc/targets/dsp/), [EGFR](https://onco.cc/targets/egfr/), [FAT1](https://onco.cc/targets/fat1/), [KAT6B](https://onco.cc/targets/kat6b/), [KEAP1](https://onco.cc/targets/keap1/), [MYH11](https://onco.cc/targets/myh11/), [NUTM2D](https://onco.cc/targets/nutm2d/), [PD-1](https://onco.cc/targets/pd1/), [PD-L1](https://onco.cc/targets/pdl1/), [SPEN](https://onco.cc/targets/spen/), [TET1](https://onco.cc/targets/tet1/), [USP9X](https://onco.cc/targets/usp9x/), [VEGF / VEGFR](https://onco.cc/targets/vegf/), [ZEB1](https://onco.cc/targets/zeb1/), [ZNF331](https://onco.cc/targets/znf331/), [ZNF521](https://onco.cc/targets/znf521/), [ZNF626](https://onco.cc/targets/znf626/), [ZNF680](https://onco.cc/targets/znf680/), [ZNF721](https://onco.cc/targets/znf721/), [ZNF780A](https://onco.cc/targets/znf780a/), [ZNF90](https://onco.cc/targets/znf90/), [ZNF93](https://onco.cc/targets/znf93/)
- drugs: [Camrelizumab](https://onco.cc/drugs/camrelizumab/), [Cisplatin](https://onco.cc/drugs/cisplatin/), [Gemcitabine](https://onco.cc/drugs/gemcitabine/), [Gemcitabine + cisplatin](https://onco.cc/drugs/gemcitabine-cisplatin/), [H101 oncolytic adenovirus](https://onco.cc/drugs/h101-oncolytic-adenovirus/), [HMBD-001](https://onco.cc/drugs/hmbd-001/), [KL-A167](https://onco.cc/drugs/kl-a167/), [MRG003](https://onco.cc/drugs/mrg003/), [Nivolumab](https://onco.cc/drugs/nivolumab/), [Pembrolizumab](https://onco.cc/drugs/pembrolizumab/), [Penpulimab](https://onco.cc/drugs/penpulimab/), [Pilocarpine](https://onco.cc/drugs/pilocarpine/), [Tislelizumab](https://onco.cc/drugs/tislelizumab/), [Toripalimab](https://onco.cc/drugs/toripalimab/), [YL201](https://onco.cc/drugs/yl201/)
- companies: [Akeso](https://onco.cc/companies/akeso/), [BeOne Medicines (formerly BeiGene)](https://onco.cc/companies/beone/), [Jiangsu Hengrui Pharmaceuticals](https://onco.cc/companies/hengrui/), [Lepu Biopharma](https://onco.cc/companies/lepu-biopharma/), [Shanghai Sunway Biotech](https://onco.cc/companies/shanghai-sunway-biotech/)
- institutions: [Sun Yat-sen University Cancer Center](https://onco.cc/institutions/sysucc/)
- pathways: [Oncogenic viruses](https://onco.cc/pathways/oncogenic-viruses/), [PD-1 / PD-L1 immune checkpoint & T-cell activation](https://onco.cc/pathways/pd1-checkpoint/)
- terms: [Circulating tumour DNA (ctDNA)](https://onco.cc/terms/ctdna/), [Plasma EBV DNA](https://onco.cc/terms/plasma-ebv-dna/), [Re-irradiation](https://onco.cc/terms/re-irradiation/)
- trials: [A Phase II Study to Evaluate HLX43 in Subjects With Recurrent/Metastatic Nasopharyngeal Carcinoma Failed or Intolerance to Second-line Therapy](https://onco.cc/trials/nct06839066/), [A Phase III Study of YL201 in Recurrent or Metastatic Nasopharyngeal Carcinoma(TAISHAN-301)](https://onco.cc/trials/taishan-301/), [A Study Comparing BL-B01D1 With Physician's Choice of Chemotherapy in Patients With Recurrent or Metastatic Nasopharyngeal Carcinoma(PANKU-NPC01)](https://onco.cc/trials/nct06118333/), [A Study of BL-B01D1+PD-1 Monoclonal Antibody in Patients With Locally Advanced or Metastatic Non-small Cell Lung Cancer, Nasopharyngeal Carcinoma and ](https://onco.cc/trials/nct06475300/), [A Study of MRG003 in Combination With Pucotenlimab Versus Chemotherapy in the Treatment of Patients With Recurrent or Metastatic Nasopharyngeal Carcin](https://onco.cc/trials/nct06976190/), [A Study of Penpulimab (AK105) in the First-line Treatment of Recurrent or Metastatic Nasopharyngeal Carcinoma](https://onco.cc/trials/nct04974398/), [A Study of SI-B003 and BL-B01D1+SI-B003 in Patients With Locally Advanced or Metastatic Non-small Cell Lung Cancer, Nasopharyngeal Carcinoma and Other](https://onco.cc/trials/nct05956587/), [A Study of YL201 in Combination With Toripalimab and With or Without Cisplatin in Nasopharyngeal Carcinoma.](https://onco.cc/trials/nct07258979/), [A Study to Evaluate the Efficacy and Safety of MRG003 in Patients With Recurrent Metastatic Nasopharyngeal Carcinoma](https://onco.cc/trials/nct05126719/), [Autologous Dendritic Cells and Allogenic Dendritic Secretomes for Patients With Advanced Nasopharyngeal Cancer](https://onco.cc/trials/nct05261750/), [AVENTINE-1: Study of AVZO-1418 as a Single Agent and in Combination Therapy in Patients With Locally Advanced or Metastatic Solid Tumors (AVZO-1418-1001)](https://onco.cc/trials/nct07038343/), [CAPTAIN-1st](https://onco.cc/trials/captain-1st/), [CONTINUUM](https://onco.cc/trials/continuum/), [Foscan®-Mediated Photodynamic Therapy Versus Brachytherapy in Patients With Nasopharyngeal Carcinoma](https://onco.cc/trials/nct01086488/), [JUPITER-02](https://onco.cc/trials/jupiter-02/), [KL-A167 Injection Combined With Cisplatin and Gemcitabine vs Placebo Combined With Cisplatin and Gemcitabine in the Treatment of Recurrent or Metastatic Nasopharyngeal Carcinoma](https://onco.cc/trials/nct05294172/)
- key papers: [Analysis of Plasma Epstein-Barr Virus DNA to Screen for Nasopharyngeal Cancer](https://onco.cc/key-papers/paper-chan-n-engl-j-med/), [CONTINUUM: induction-concurrent chemoradiotherapy with or without sintilimab in locoregionally advanced nasopharyngeal carcinoma](https://onco.cc/key-papers/paper-continuum-sintilimab-nasopharyngeal-liu-lancet-2024/)
- journals: [Tumour virus research](https://onco.cc/journals/tumour-virus-research/)
- people: [Anthony T. C. Chan](https://onco.cc/people/anthony-chan/), [Goh Boon Cher](https://onco.cc/people/goh-boon-cher/)
- collections: [CSCO guidelines (China)](https://onco.cc/collections/csco-guidelines/)
- cancers: [Locoregionally advanced nasopharyngeal carcinoma (stage III to IVA)](https://onco.cc/cancers/locoregionally-advanced-nasopharyngeal-carcinoma/), [Lymphoepithelial carcinoma of the lung](https://onco.cc/cancers/lymphoepithelial-carcinoma-lung/), [Rare cancers of childhood (NCI PDQ umbrella)](https://onco.cc/cancers/rare-childhood-cancers/), [Recurrent and metastatic nasopharyngeal carcinoma](https://onco.cc/cancers/recurrent-metastatic-nasopharyngeal-carcinoma/)

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JSON: https://onco.cc/api/v1/entities/nasopharyngeal.json