Controversies in the systemic treatment of nasopharyngeal carcinoma

In conjunction with radiotherapy, the concurrent use of systemic chemotherapy has been proven to improve treatment outcome and thus have been incorporated into the treatment paradigm for patients with loco-regionally advanced Nasopharyngeal carcinoma. The benefits from the use of chemotherapy in stage II disease remain controversial. There is now also increasing evidence for the use of neoadjuvant chemotherapy prior to definitive concurrent chemoirradiation, which is associated with decreased risks of distant metastases, translating to improvement in overall survival. Dose intensity of chemotherapy administered during radiotherapy has been shown to have prognostic significance in NPC treatment. The role of adjuvant chemotherapy after completion of concurrent chemoirradiation is less well defined, with studies indicating an insignificant survival improvement. However, this approach may still be of value in patients with high-risk disease. Data in support of this approach shall become available in the coming years. This article will discuss and highlight these findings and controversies in systemic treatment of NPC.