Treatments for metastatic or recurrent nasopharyngeal carcinoma (NPC) may include chemotherapy, radiation, surgery, targeted drug therapy, and immunotherapy.
NPC is a cancer that occurs in the head and neck. It begins in the upper parts of the throat behind the nose, as well as near the base of the skull.
In some cases, NPC may spread to other parts of the body. This is known as metastatic cancer. NPC may also return after initial treatment. This is known as recurrent NPC.
This article discusses the treatment options for NPC and when a doctor may recommend them.
Treatment options for NPC vary based on the stage of cancer and whether it is recurrent.
If the cancer is recurrent, factors that may influence treatment decisions include:
- the extent of the cancer
- where it has returned
- previous treatments for NPC
- overall health
NPC is uncommon in the United States. Each year, there is less than
Options for treating NPC at advanced stages or when it returns include:
- targeted therapy
Chemotherapy may be an option in more advanced NPC or if it has returned to distant sites.
This treatment involves administering anticancer drugs via the mouth or an intravenous (IV) infusion. This typically occurs in a cycle in which a drug or a combination of chemotherapy drugs are delivered on a specific schedule, followed by a period of rest.
Chemotherapy can be a stand-alone treatment, alongside radiation or immunotherapy, or with other drugs.
Combining chemotherapy with other drugs may cause tumors to shrink more effectively but may also cause more side effects.
Besides being an initial treatment option for NPC, radiation therapy may be advisable if the cancer has spread or has returned after initial treatments.
Radiation therapy kills cancer cells or slows their growth using high energy X-ray.
Intensity-modulated radiation therapy (IMRT) is a
This involves a machine that moves around the person, allowing the technician to aim X-ray beams at the tumor from different angles. They can adjust the dosage and intensity of the beams so that nearby tissues and other structures are not as affected by the radiation.
The benefit of this approach is that a higher dose of radiation can be delivered to the tumor while reducing side effects.
Typically, this type of therapy is given 5 days a week for 6–7 weeks.
An oncologist may recommend surgery if other treatments have been ineffective, if the cancer has spread, or if it has returned.
A surgical procedure known as an
If NPC returns or spreads to the lymph nodes in the neck, a doctor may recommend surgery to remove them. This may occur if they believe further radiation would cause too many side effects or if prior radiation was ineffective. In this case, a neck dissection occurs to remove lymph nodes affected by cancer.
A benefit to surgery is that a doctor is able to examine removed tumors in the lab to make sure no cancer remains in the body. They may also examine lymph nodes in the lab for cancer cells.
Targeted drug therapy uses medication that targets specific types of protein on cancer cells. They
A person receives these drugs in pill form or via infusion, and they may have less severe side effects than chemotherapy.
If NPC has spread, recurred to a distant site, or grown after initial treatment with chemotherapy, doctors may use a targeted infusion medication called cetuximab (Erbitux) alongside chemotherapy.
This is a synthetic version of an immune system protein called a monoclonal antibody. It targets a type of protein on the surface of cancer cells that allows them to divide and grow. Scientists are still studying the effectiveness of the medication in treating NPC.
Cetuximab is delivered via an IV infusion either once every week or once every other week.
Immunotherapy works by boosting the immune system to help it locate and destroy cancer cells more effectively.
Often, immunotherapy has
A doctor may use drugs called PD-1 inhibitors if radiation or surgery cannot treat NPC, if the cancer is metastatic, or if it has returned after treatment.
PD-1 inhibitors include:
- pembrolizumab (Keytruda)
- nivolumab (Opdivo)
Doctors deliver pembrolizumab via an IV infusion, usually every 3 or 6 weeks.
A person receives nivolumab via an IV infusion every 2 or 4 weeks.
If NPC has metastasized or returned after initial treatment, several treatment options are available. The type of treatment may depend on factors such as the extent and location of the cancer, previous treatments, and the person’s overall health.
Treatment options include chemotherapy, radiation, surgery, targeted drug therapy, and immunotherapy.
As NPC forms in an area of the body with many critical structures, it is important to work with a cancer center experienced in treating this type of cancer.