Nasopharyngeal carcinoma
Prepared with OnCo (onco.cc/prep/nasopharyngeal/). Orientation, not medical advice; your team knows your case.
My details
What I know, what is unclear, changes to discuss
Saved in this browserMy questions
15 on the sheet- 1.What is my exact diagnosis, stage, and grade, and which tests established them?
- 2.Which biomarkers have been tested on my tumour (for example Plasma EBV DNA, EBER in situ hybridisation on biopsy, TNMstage, PD-L1, Post-radiotherapy detectable EBV DNA), and what were the results?
- 3.Which subtype is my cancer, and does that change the recommended treatment?
- 4.Is germline (inherited) genetic testing recommended for me or my family?
- 5.For my situation (stage i), which of the standard options do you recommend and why?
- 6.For my situation (stage ii-iva), which of the standard options do you recommend and why?
- 7.Am I a candidate for Gemcitabine + cisplatin, Cisplatin, and what side effects should I expect?
- 8.For my situation (recurrent/metastatic, first line), which of the standard options do you recommend and why?
- 9.Am I a candidate for Toripalimab, Camrelizumab, Tislelizumab or related drugs, and what side effects should I expect?
- 10.For my situation (local recurrence), which of the standard options do you recommend and why?
- 11.Are there clinical trials I could join, for example of Toripalimab, Penpulimab, Camrelizumab, Tislelizumab?
- 12.Would a second opinion at a high-volume centre change anything, and can you help arrange it?
- 13.What supportive care (symptom control, nutrition, exercise, mental health, financial help) is available from the start?
- 14.I read that “Radiation late effects in a disease cured young”. How does that affect my plan?
- 15.I read that “Western access to PD-1 inhibitors studied in Asia; regulatory lag”. How does that affect my plan?
The words I may hear
- Plasma EBV DNA: Fragments of Epstein-Barr virus DNA in the blood that measure nasopharyngeal carcinoma: used to screen healthy people in endemic regions, to stage, to decide who needs extra treatment after radiotherapy, and to detect relapse.
- Re-irradiation: Giving radiotherapy again to a region that has already been treated, once thought impossible because normal tissues remember the first dose.
- Circulating tumour DNA (ctDNA): Circulating tumour DNA (ctDNA) consists of fragments of DNA shed by tumour cells into the blood, detectable with sensitive sequencing.
Tests and results to bring
Biomarker results to ask for: 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).
Scans and tests linked to this cancer: Liquid biopsy (ctDNA).
Bring copies of scan reports, pathology and blood results, and a list of every medicine and supplement.
The treatments I may be offered
- Stage I: IMRT alone (70 Gy) to nasopharynx and elective neck. (IMRT / IGRT (modern external beam))
- 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, Cisplatin, IMRT / IGRT (modern external beam))
- Recurrent/metastatic, first line: Gemcitabine-cisplatin + PD-1 inhibitor (toripalimab, camrelizumab, tislelizumab or penpulimab), then PD-1 maintenance. (Toripalimab, Camrelizumab, Tislelizumab, Penpulimab, 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), Transoral robotic surgery (TORS))
From the standard of care recorded for this cancer; which apply depends on your stage and biomarkers. Ask which the team recommends and why.