OnCo
cancersCancer

Nasopharyngeal carcinoma

aka NPC

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.

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.

State of the art today

  • 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.
Who it affects

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.

Where the cases are

Cases by country · GLOBOCAN 2022
All countries →

No country-level case numbers. This cancer is not mapped to a GLOBOCAN site.

Standard of care

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Stage I

IMRT alone (70 Gy) to nasopharynx and elective neck.

NCCN · Category 2A
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).

NCCN · Category 1 (induction GP)ESMO-MCBS · A
Gemcitabine + cisplatinCisplatinIMRT / IGRT (modern external beam)
Recurrent/metastatic, first line

Gemcitabine-cisplatin + PD-1 inhibitor (toripalimab, camrelizumab, tislelizumab or penpulimab), then PD-1 maintenance.

NCCN · Category 1 (toripalimab + GP)ESMO-MCBS · 4
ToripalimabCamrelizumabTislelizumabPenpulimabGemcitabine + 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)

Subtypes & biomarkers

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Subtypes
Biomarkers clinicians test

Target prevalence in this cancer

History

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  1. 1921Regaud and Schmincke describe lymphoepithelioma
  2. 1966EBV antibodies linked to NPC (Old et al.)
  3. 1998Intergroup 0099: concurrent cisplatin-RT improves survival (Al-Sarraf)
    Cisplatin
  4. 1999Plasma EBV DNA quantified as a tumour marker (Lo, Cancer Res)
  5. 2017EBV DNA screening detects early NPC in 20,000 men (Chan, NEJM)
  6. 2019Induction gemcitabine-cisplatin improves survival (Zhang, NEJM)
    Gemcitabine + cisplatin
  7. 2021JUPITER-02, CAPTAIN-1st, RATIONALE-309: PD-1 + GP first line
    ToripalimabCamrelizumabTislelizumab
  8. 2023Toripalimab: first FDA approval for NPC
    Toripalimab
  9. 2025Penpulimab approved (FDA)
    Penpulimab

Pipeline

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ApprovedMonoclonal antibody (anti-PD-1)
Toripalimab · Loqtorzi
Not mapped hereAnti-PD-1 monoclonal antibody (IgG1, Fc-engineered null)
Penpulimab · Penpulimab-kcqx
Under reviewMonoclonal antibody (anti-PD-1)
Camrelizumab · AiRuiKa
ApprovedMonoclonal antibody (anti-PD-1)
Tislelizumab · Tevimbra
Proton therapy

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 remains the main cause of death after chemoradiation.

Trials

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Recruiting now (live from ClinicalTrials.gov)

Recruiting trials near you · live from ClinicalTrials.gov
Nasopharyngeal carcinoma
condition: Nasopharyngeal carcinoma
Open on ClinicalTrials.gov →

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Expert centres

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Where the expertise is

Centres linked to this cancer in OnCo

Seeking a second opinion: ask your oncologist for a referral to a high-volume centre; most accept records and pathology by mail or telehealth. In the US, use the NCI's Find a Cancer Center tool or the nonprofit Cancer Commons, which navigates options for advanced cancers at no cost.

Questions to ask

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Bring to your appointment

Questions to ask your oncologist about Nasopharyngeal carcinoma

Generated from this cancer's standard of care, biomarkers, and pipeline · 15 questions

Newly diagnosed

  1. What is my exact diagnosis, stage, and grade, and which tests established them?
    Why: Everything else follows from an accurate stage and subtype.
  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?
    Why: These results decide eligibility for targeted therapy, immunotherapy, and trials.
  3. Which subtype is my cancer, and does that change the recommended treatment?
    Why: Recognised subtypes for this cancer include Non-keratinising undifferentiated, Non-keratinising differentiated, Keratinising squamous.
  4. Is germline (inherited) genetic testing recommended for me or my family?
    Why: Inherited variants can change treatment and matter for relatives.

Stage I

  1. For my situation (stage i), which of the standard options do you recommend and why?
    Why: Guideline options include: IMRT alone (70 Gy) to nasopharynx and elective neck.

Stage II-IVA

  1. For my situation (stage ii-iva), which of the standard options do you recommend and why?
    Why: Guideline options include: 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).
  2. Am I a candidate for Gemcitabine + cisplatin, Cisplatin, and what side effects should I expect?
    Why: Knowing the expected toxicities helps you plan work, family, and supportive care.

Recurrent/metastatic, first line

  1. For my situation (recurrent/metastatic, first line), which of the standard options do you recommend and why?
    Why: Guideline options include: Gemcitabine-cisplatin + PD-1 inhibitor (toripalimab, camrelizumab, tislelizumab or penpulimab), then PD-1 maintenance.
  2. Am I a candidate for Toripalimab, Camrelizumab, Tislelizumab or related drugs, and what side effects should I expect?
    Why: Knowing the expected toxicities helps you plan work, family, and supportive care.

Local recurrence

  1. For my situation (local recurrence), which of the standard options do you recommend and why?
    Why: Guideline options include: Endoscopic or open nasopharyngectomy for resectable rT1-3 (better survival than re-irradiation, Liu Lancet Oncol 2021); hyperfractionated re-IMRT otherwise.

Any stage

  1. Are there clinical trials I could join, for example of Toripalimab, Penpulimab, Camrelizumab, Tislelizumab?
    Why: Trials are how the next standard of care is set; asking early keeps options open.
  2. Would a second opinion at a high-volume centre change anything, and can you help arrange it?
    Why: Rare or high-stakes decisions benefit from a centre that treats many similar patients.
  3. What supportive care (symptom control, nutrition, exercise, mental health, financial help) is available from the start?
    Why: Supportive care improves quality of life and helps patients complete treatment.
  4. I read that “Radiation late effects in a disease cured young”. How does that affect my plan?
    Why: Open problems are where trials and second opinions matter most.
  5. I read that “Western access to PD-1 inhibitors studied in Asia; regulatory lag”. How does that affect my plan?
    Why: Open problems are where trials and second opinions matter most.

Print this page for your appointment (your browser's print command). These prompts are for discussion; your clinical team knows your case.

Everything relevant

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Direct links plus the targets, companies, and technologies of this cancer's products.

technologies

9
Cytotoxic chemotherapyImmune checkpoint inhibitorsIMRT / IGRT (modern external beam)Intravesical therapy (BCG, chemotherapy, devices, gene and viral therapy)Liquid biopsy (ctDNA)Platinum agentsProton therapyTCR-T cell therapyTransoral robotic surgery (TORS)

targets

4
EGFRPD-1PD-L1VEGF / VEGFR

drugs

9
Under reviewMonoclonal antibody (anti-PD-1)
Camrelizumab · AiRuiKa
ApprovedCytotoxic chemotherapy (platinum)
Cisplatin · Platinol (generic)
Not mapped hereNucleoside analogue (deoxycytidine)
Gemcitabine · Gemzar / Infugem
Not mapped hereCytotoxic regimen
Gemcitabine + cisplatin
ApprovedMonoclonal antibody (anti-PD-1)
Nivolumab · Opdivo / Opdivo Qvantig (SC)
ApprovedMonoclonal antibody (anti-PD-1)
Pembrolizumab · Keytruda / Keytruda Qlex (SC)
Not mapped hereAnti-PD-1 monoclonal antibody (IgG1, Fc-engineered null)
Penpulimab · Penpulimab-kcqx
ApprovedMonoclonal antibody (anti-PD-1)
Tislelizumab · Tevimbra
ApprovedMonoclonal antibody (anti-PD-1)
Toripalimab · Loqtorzi

companies

7
AkesoBeOne Medicines (formerly BeiGene)Bristol Myers SquibbEli Lilly (incl. Loxo)Jiangsu Hengrui PharmaceuticalsJiangsu Hengrui PharmaceuticalsMerck & Co. (MSD)

institutions

1
Sun Yat-sen University Cancer Center

pathways

2
Oncogenic virusesPD-1 / PD-L1 immune checkpoint & T-cell activation

terms

2
Circulating tumour DNA (ctDNA)Plasma EBV DNA

collections

1
CSCO guidelines (China)

Latest papers

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Latest papers · live from Europe PMC
Open in Europe PMC

Query for this cancer: (TITLE:"Nasopharyngeal carcinoma" OR ABSTRACT:"Nasopharyngeal carcinoma" OR TITLE:"NPC" OR ABSTRACT:"NPC") AND (treatment OR therapy OR trial OR survival OR diagnosis). Results are unfiltered search hits about Nasopharyngeal carcinoma, not a curated reading list.

Connected

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technologies

7
Immune checkpoint inhibitorsIMRT / IGRT (modern external beam)Liquid biopsy (ctDNA)Platinum agentsProton therapyTCR-T cell therapyTransoral robotic surgery (TORS)

targets

4
EGFRPD-1PD-L1VEGF / VEGFR

drugs

9
Under reviewMonoclonal antibody (anti-PD-1)
Camrelizumab · AiRuiKa
ApprovedCytotoxic chemotherapy (platinum)
Cisplatin · Platinol (generic)
Not mapped hereNucleoside analogue (deoxycytidine)
Gemcitabine · Gemzar / Infugem
Not mapped hereCytotoxic regimen
Gemcitabine + cisplatin
ApprovedMonoclonal antibody (anti-PD-1)
Nivolumab · Opdivo / Opdivo Qvantig (SC)
ApprovedMonoclonal antibody (anti-PD-1)
Pembrolizumab · Keytruda / Keytruda Qlex (SC)
Not mapped hereAnti-PD-1 monoclonal antibody (IgG1, Fc-engineered null)
Penpulimab · Penpulimab-kcqx
ApprovedMonoclonal antibody (anti-PD-1)
Tislelizumab · Tevimbra
ApprovedMonoclonal antibody (anti-PD-1)
Toripalimab · Loqtorzi

companies

4
AkesoBeOne Medicines (formerly BeiGene)Jiangsu Hengrui PharmaceuticalsJiangsu Hengrui Pharmaceuticals

institutions

1
Sun Yat-sen University Cancer Center

pathways

2
Oncogenic virusesPD-1 / PD-L1 immune checkpoint & T-cell activation

terms

2
Circulating tumour DNA (ctDNA)Plasma EBV DNA

collections

1
CSCO guidelines (China)