Optimal management of nasopharyngeal carcinoma

Purpose of review Given the high rate of mortality still associated with advanced stages of nasopharyngeal carcinoma, this review focuses on some specific aspects of this potentially curable disease that could translate into improved therapeutic approaches. Recent findings Epstein-Barr viral-induced carcinogenesis is almost constantly reported in the undifferentiated type of nasopharyngeal carcinoma. Nasopharyngeal carcinoma retains clonal characteristics and p53 functionality up to late stages that may account for its high level of chemo- and radiotherapy sensitivity, with several cases of long-term survivors reported among patients with bone metastasis. Recent imaging and biologic techniques will help to identify patients at risk of distant failures (detection of plasma Epstein-Barr virus DNA) or those harboring posttherapeutic residual diseases (positron emission tomographic scan). Cisplatin-based induction chemotherapy has shown disease-free survival benefit, whereas concomitant chemoradiotherapy is associated with an improved local-regional control. Late radiation-induced toxicities (especially xerostomia) will hopefully be reduced using intensity-modulated radiation therapy. New therapeutic agents such as taxanes, or targeted therapies (epidermal growth factor receptor inhibitors) are of major interest in the challenge of circumventing resistance to alkylating agents. Summary Better knowledge of nasopharyngeal carcinoma pathogenesis and biology, management of patients in highly specialized oncologic units, and careful selection of cytotoxic agents along with multimodality integrated therapeutic programs will likely yield to improved survival, particularly for patients with locally advanced nasopharyingeal carcinoma.