What's New in Nasopharyngeal Cancer Research?

Research into the causes, prevention, and treatment of nasopharyngeal cancer (NPC) is being done at many university hospitals, medical centers, and other institutions around the world. Because NPC is rare, it has been hard to study it well. Most experts agree that treatment in a clinical trial should be considered for any type or stage of NPC.

Causes, prevention, and early detection

Many studies are looking at how Epstein-Barr virus (EBV) infection as well as other risk factors cause cells of the nasopharynx to become cancer.These studies may someday lead to vaccines to help prevent some cases of NPC by preventing EBV infection.

Discoveries about EBV, its interaction with nasopharyngeal cells, and the immune system’s reaction to EBV have led to new blood tests, such as measuring levels of EBV DNA, that is helping to detect NPC early and being studied as a way to screen people at high risk. Researchers are also finding certain gene changes in the EBV that can make a person more likely to develop NPC .These questions are now being studied in areas of the world where this cancer is more common.

Treatment

Epstein-Barr virus (EBV) DNA

New radiation therapy techniques

Most types of radiation therapy use radiation in the form of x-rays (photons). Other types of radiation use protons and carbon ions to kill cancer cells. These are being studied, especially in China, but so far haven't been proven to be better than standard x-ray radiation. Some studies are also investigating proton therapy along with photon therapy. 

Doctors are also studying the best dose of radiation therapy, especially if someone has had a good response to induction (upfront) chemotherapy. Some studies are evaluating if a lower dose of radiation can be given if the NPC has shrunken quite a bit because chemotherapy was given first.

Chemotherapy

Researchers continue to develop new chemo drugs, new drug combinations, and new ways to give drugs that might be more effective against advanced NPC. Several drugs that are already used to treat other cancers, such as capecitabine, oxaliplatin, and gemcitabine, have been studied for use against NPC as well. Clinical trials are looking for the best combination of chemo drugs and how they should be used along with radiation therapy. Studies have shown that for more advanced stages of NPC, giving chemotherapy first, called induction chemo, and then chemoradiation, can help some people live longer. Other research is being done on earlier-stage NPC to determine if chemo should be given after radiation therapy, if high levels of EBV DNA are found in the blood.

Immunotherapy

NPC seems to be caused at least in part by infection with the Epstein-Barr virus (EBV). Although patients’ immune systems can react against EBV, this doesn’t seem to be enough to kill the cancer. Finding and targeting cell proteins linked to EBV and the cells it affects could lead to new, more cancer-focused treatment options. Understanding how EBV interacts with the immune system could also lead to treatments that boost the immune system's response to NPC and maybe even keep it from developing.

Immunotherapy drugs, like PD-1 inhibitors, are approved to treat some people with NPC after the cancer has come back (recurred) or spread (metastasized). Studies are looking to see if adding immunotherapy drugs to chemoradiation upfront might help shrink cancers more than chemoradiation alone. 

Predicting treatment outcomes

Researchers are looking for ways to know how well NPC will respond to treatment and understand how likely it is to come back after treatment. This information would allow doctors to tailor treatment for each patient so that the best treatment is used. One area of research is looking for a link between a person's blood EBV DNA levels before treatment, the cancer stage, and overall survival. Results have suggested there is a link between low levels of pre-treatment EBV DNA and early-stage cancers and better outcomes, but much more research is needed. Some studies are trying to find out if using EBV DNA levels after treatment could help predict a person’s outcome.