Recurrent and metastatic nasopharyngeal carcinoma: lines of therapy

Cancer page →

5 standard-of-care settings across 3 lines and 1 biomarker subgroup. Rows come from the cancer page's standard of care; the grid places each on its line and subgroup.

Line	All comers
Advanced, first line	1
Second line	3
Special situations	1

Advanced, first line

Subgroup	Setting	Approach	Products and trials	Guideline	Evidence
All comers	Metastatic disease, first line	Gemcitabine and cisplatin with a PD-1 antibody (toripalimab, JUPITER-02; camrelizumab, CAPTAIN-1st; tislelizumab; penpulimab), then PD-1 maintenance; locoregional radiotherapy to the primary in patients with a good response.	Gemcitabine + cisplatinToripalimabJUPITER-02CamrelizumabCAPTAIN-1stTislelizumabPenpulimabA Study of Penpulimab (AK105) in the First-line Treatment of Recurrent or Metastatic Nasopharyngeal CarcinomaIMRT / IGRT (modern external beam)Immune checkpoint inhibitors	CSCO/ASCO guideline on nasopharyngeal carcinoma 2021; NCCN Head and Neck Cancers	99

Second line

Subgroup	Setting	Approach	Products and trials	Guideline	Evidence
All comers	Resectable local recurrence	Endoscopic nasopharyngectomy (better survival and fewer complications than re-irradiation in a randomised trial); neck dissection for nodal recurrence.	Transoral robotic surgery (TORS)Robotic & minimally invasive surgeryLymphadenectomy (lymph node dissection)	CSCO/ASCO guideline on nasopharyngeal carcinoma 2021; NCCN Head and Neck Cancers	40
All comers	Unresectable local recurrence	Hyperfractionated intensity-modulated re-irradiation or proton therapy with careful dose constraints; systemic therapy where re-irradiation is unsafe.	Re-irradiationIMRT / IGRT (modern external beam)Proton therapy	CSCO/ASCO guideline on nasopharyngeal carcinoma 2021; NCCN Head and Neck Cancers	93
All comers	After platinum and PD-1 therapy	Gemcitabine, taxane or capecitabine-based chemotherapy; nivolumab or pembrolizumab if no prior PD-1 antibody; trials of antibody-drug conjugates (MRG003, BL-B01D1, YL201) and EBV-specific T cells.	NivolumabPembrolizumabCapecitabineA Phase III Study of YL201 in Recurrent or Metastatic Nasopharyngeal Carcinoma(TAISHAN-301)KL-A167 Injection Combined With Cisplatin and Gemcitabine vs Placebo Combined With Cisplatin and Gemcitabine in the Treatment of Recurrent or Metastatic Nasopharyngeal CarcinomaA Study Comparing BL-B01D1 With Physician's Choice of Chemotherapy in Patients With Recurrent or Metastatic Nasopharyngeal Carcinoma(PANKU-NPC01)A Study of MRG003 in Combination With Pucotenlimab Versus Chemotherapy in the Treatment of Patients With Recurrent or Metastatic Nasopharyngeal CarcinA Study to Evaluate the Efficacy and Safety of MRG003 in Patients With Recurrent Metastatic Nasopharyngeal CarcinomaA Phase II Study to Evaluate HLX43 in Subjects With Recurrent/Metastatic Nasopharyngeal Carcinoma Failed or Intolerance to Second-line TherapyTCR-T cell therapy	CSCO/ASCO guideline on nasopharyngeal carcinoma 2021; NCCN Head and Neck Cancers	98

Special situations

Subgroup	Setting	Approach	Products and trials	Guideline	Evidence
All comers	Oligometastatic disease	Stereotactic radiotherapy or resection of limited metastases with systemic therapy.	SBRT / SABR (stereotactic radiotherapy)	CSCO/ASCO guideline on nasopharyngeal carcinoma 2021; NCCN Head and Neck Cancers	40

Lines and subgroups are parsed from the setting text of each standard-of-care row and can misclassify an unusual phrasing; the row’s own setting is always shown. Guideline chips reflect the NCCN category and ESMO-MCBS grade recorded on the cancer page, checked on its stated date. Not medical advice.