A prospective multicentre phase II study of cisplatin and weekly docetaxel as first-line treatment for recurrent or metastatic nasopharyngeal cancer (KCSG HN07-01). The full terms of this license are available at https://www.dovepress.com/terms.php and incorporate the Creative Commons Attribution - Non Commercial (unported, v3.0) License. Gnoni A, Silvestris N, Licchetta A, et al. Because of radiation resistance, the prognosis of re-irradiation is poor for recurrent nasopharyngeal carcinoma. Head Neck. Become a volunteer, make a tax-deductible donation, or participate in a fundraising event to help us save lives. LMP-1 and 2, as well as EBNA, are recognized by the immune system as non-self, provoking a considerable immune response. 2011;30:114–119. We also retain data in relation to our visitors and registered users for internal purposes and for sharing information with our business partners. Nasopharyngeal cancer treatment options include radiation therapy, chemoradiation followed by adjuvant chemotherapy, surgery, and chemotherapy. VEGF-R overexpression has been found in 60%–67% of patients affected with NPC and is linked to poor prognosis.34 Several oral available multikinase inhibitors have been tested in Phase II clinical trials in patients with recurrent NPC. What does it take to outsmart cancer? Life after cancer means returning to some familiar things and also making some new choices. If you have (or have had) NPC, you probably want to know if there are things you can do that might lower your risk of the cancer growing or coming back, such as exercising, eating a certain type of diet, or taking nutritional supplements. It's very important to report any new symptoms to the doctor right away, because they may prompt your doctor to do tests that could help find recurrent cancer as early as possible. Liu J, Yu H, Sun X, et al. Standard-of-care treatment for recurrent NPC is composed of platinum-containing multiagent chemotherapy.11 Despite numerous clinical trials, development of new systemic therapies for recurrent NPC, in the past 20 years, has been scarce. Cancer Treat Res. J Buon. From basic information about cancer and its causes to in-depth information on specific cancer types – including risk factors, early detection, diagnosis, and treatment options – you’ll find it here. Early-stage and locally advanced NPC generally carry a good prognosis, but for patients with recurrent/metastatic disease, options are limited. 1991;9(9):1675–1681. 2011;22(6):1280–1287. Despite definitive radiation therapy, loco-regional recurrence is observed in 10–58% of patients with nasopharyngeal cancer (NPC) and the majority of all recurrences develop within 3 years after radiation therapy . Phase II study of sorafenib in combination with cisplatin and 5-fluorouracil to treat recurrent or metastatic nasopharyngeal carcinoma. Chemotherapy and radiotherapy in nasopharyngeal carcinoma: an update of the MAC-NPC meta-analysis. Chua DT, Wei WI, Wong MP, Sham JS, Nicholls J, Au GK. Oncologist. Cancer. We couldn’t do what we do without our volunteers and donors. The results indicated that the median progression-free survival (PFS) was 7 months in the experimental arm and 5.6 months in the standard group (HR 0.55; P<0.0001), and overall response rate (ORR) was 64% in the gemcitabine arm and 42% in the 5-fluorouracil arm. T1 and T2 recurrent NPCs, for example, should be treated with re-irradiation, because they have good probabilities to respond and the related toxicities are low and manageable.41,42 On the other hand, re-irradiation in T3 and T4 recurrent NPCs is accompanied by high toxicity and low probability of response.41–43 Surgery in the case of nasopharyngeal recurrence is difficult to perform, and there are only anecdotic data in literature regarding the nasopharyngectomy. Fujii M, Yamashita T, Ishiguro R, Tashiro M, Kameyama K. Significance of epidermal growth factor receptor and tumor associated tissue eosinophilia in the prognosis of patients with nasopharyngeal carcinoma. Hua YJ, Han F, Lu LX, et al. Coexpression of hypoxia-inducible factors 1alpha and 2alpha, carbonic anhydrase IX, and vascular endothelial growth factor in nasopharyngeal carcinoma and relationship to survival. The authors report no conflicts of interest in this work. Chan AT, Teo PM, Johnson PJ. Outcome of fractionated stereotactic radiotherapy for 90 patients with locally persistent and recurrent nasopharyngeal carcinoma. Once the diagnosis is confirmed, your doctor orders other tests to determine the extent (stage) of the cancer, such as imaging tests. 2016;8(12):106. Crossref, Medline, Google Scholar; 24 Wei WI, Mok VW. Considering the limited efficacy (especially for r-T3/4 disease) and the high probability of fatal complications, the 2-year OS rate is limited to only ~40%.45. In both cases, it is a demolition intervention, and the post-surgical outcome may be difficult. This doesn’t mean that no supplements will help, but it’s important to know that none have been proven to do so. •  Testimonials   FP regimen showed the worse results, with a 1-year OS rate of 0.63. Tumor vaccines constitute the easier strategy; however, there are only few of them available in the clinical practice. For permission for commercial use of this work, please see paragraphs 4.2 and 5 of our Terms. Volume 2019:12 Pages 1583—1591, Editor who approved publication: For more general information on dealing with a recurrence, you may also want to see When Your Cancer Comes Back: Cancer Recurrence. Ex vivo expansion of tumor-infiltrating lymphocytes from nasopharyngeal carcinoma patients for adoptive immunotherapy. Learn more in Second Cancers After nasopharyngeal Cancer. Hui EP, Chan AT, Pezzella F, et al. Han F, Zhao C, Huang SM, et al. Computerized tomography (CT) 2. Number 3099067. Most doctors recommend follow-up exams at least every few months for the first 2 years after treatment, then less often as time goes on. Keywords: nasopharyngeal carcinoma, re-irradiation, poly-chemotherapy, radioresistant, immunotherapy, Nasopharyngeal carcinoma (NPC) represents a rare disease in the Western countries, such as Europe and USA, while its frequency reaches 20 cases per 100,000 people in the Eastern countries, such as China, Japan, and Singapore.1,2 From the histologic point of view, we can recognize two main types, namely squamous cell carcinoma and undifferentiated carcinoma, whose frequency often depends on the geographic area where the tumor is diagnosed. There are different forms of radiation therapy, including 3D conformal radiation therapy, intensity-modulated radiation therapy, particle beam therapyand brachytherapy, which are commonly used in the treatments of cancers of the head and neck. Cancer is calledrecurrentwhen it come backs after treatment. In the above-mentioned study, the authors identified some features related to poor prognosis in re-irradiated patients. Ann Oncol. Thus, a number of strategies to increase the specificity of T-lymphocytes against TAA have been developed, and the most recent is the CAR (chimeric antigen receptors) technology. Unfortunately, the results in terms of activity and efficacy have not been so encouraging, and hence these strategies are not included among the standards.53–55. 2016;17(12):1585–1590. Caponigro F, Longo F, Perri F, Ionna F. Docetaxel in the management of head and neck cancer. Finally, the most used immunotherapy strategy, especially in the last years, is the modification of the tumor microenvironment (TME), which helps in eliminating the inhibitory stimuli that the TME exerts on the immune cells. Mccarthy JS, Tannock IF, Degendorfer P, Panzarella T, Furlan M, Siu LL. 2002;8(8):2595–2604. Kyi C, Postow MA. 2017;35(36):4050–4056. Nasopharyngeal carcinoma (NPC) patients with retropharyngeal lymph node (RPLN) recurrence typically undergo reirradiation and experience severe radiotoxicity. Anticancer Drugs. Amm E, Crittenden M, Wargo J. The study enrolled 362 patients and randomly assigned them to receive gemcitabine plus cisplatin (experimental arm) or 5-fluorouracil plus cisplatin (standard arm). The more radical techniques should be preferred in site of the endoscopic nasopharyngectomy, being the firsts much more radical and thus usable also for locally advanced diseases. Combined chemo-radiotherapy in locally advanced nasopharyngeal carcinomas. This is when the chance of successful treatment is greatest. Int J Clin Oncol. Learning to live with cancer that does not go away can be difficult and very stressful. Boussen H, Cvitkovic E, Wendling JL, et al. 2008;30(7):863–867. In fact, NPC survivors are at higher risk for getting some other types of cancer. A triplet chemotherapy regimen of cisplatin, fluorouracil and paclitaxel for locoregionally recurrent nasopharyngeal carcinoma cases contraindicated for re-irradiation/surgery. Perri F, della Vittoria Scarpati G, Buonerba C, et al. Chemotherapy with cisplatin and continuous infusion of 5-fluorouracil and bleomycin for recurrent and metastatic nasopharyngeal carcinoma in Taiwan. 2011;22(3):718–722. However, a subset of almost 10% of patients with NPC remains affected by radioresistant disease and develop local recurrences.39 In these patients, nasopharyngectomy or re-irradiation may be the only curative options. Shiu WCT, Tsao SY. Open access peer-reviewed scientific and medical journals. Yang L, Hong S, Wang Y, et al. Sorafenib is also able to inhibit the VEGF-R, affecting the downstream pathways related to its stimulation. Hemorrhagic complications in a phase II study of sunitinib in patients of nasopharyngeal carcinoma who has previously received high-dose radiation. We offer real benefits to our authors, including fast-track processing of papers. At the American Cancer Society, we’re on a mission to free the world from cancer. CAR are chimeric transmembrane receptors constituted by an antigen-specific single-chain variable fragment (against a predetermined TAA) fused with the CD3 intracellular domain (the so-called TCR, namely T-cell receptor). Nat Rev Clin Oncol. If the cancer does recur at some point, your treatment options will depend on where the cancer is located, what treatments you’ve had before, and your overall health. This is the time for you to talk to your cancer care team about any changes or problems you notice and any questions or concerns you have. In fact, PD-L1 expression is reported to occur in 89%–95% of NPC tumors. 2018;40(3):622–631. The American Cancer Society medical and editorial content team. Long-term treatment outcome of recurrent nasopharyngeal carcinoma treated with salvage intensity modulated radiotherapy. You may be relieved to finish treatment, yet it’s hard not to worry about cancer coming back. Lancet Oncol. 2005;41(6):589–595. Eggermont AM, Maio M, Robert C. Immune checkpoint inhibitors in melanoma provide the cornerstones for curative therapies. Sometimes radiation therapy, proton beam therapy, or chemotherapy are incorporated into the treatment of recurrent nasopharyngeal carcinoma. When Your Cancer Comes Back: Cancer Recurrence. If you agree to our use of cookies and the contents of our Privacy Policy please click 'accept'. Radiology. The above percentage of manuscripts have been rejected in the last 12 months. Several trials reported on poly-chemotherapy for recurrent NPC which demonstrated encouraging response rates but was also associated with more treatment-related toxicities, and more importantly, they have not been compared with the standard cisplatin–fluorouracil or gemcitabine–cisplatin doublet regimen.19,20, In patients who develop disease progression after first-line chemotherapy, treatment options are scarce, because there are few clinical trials assessing the efficacy of chemotherapy as second-line therapy. Antibodies against CTLA-4 are widely employed in clinics for the treatment of several solid tumors. Surgical salvage of persistent or recurrent nasopharyngeal carcinoma with maxillary swing approach-critical appraisal after 2 decades. 1992;23(4):881–884. Dietary supplements are not regulated like medicines in the United States – they do not have to be proven effective (or even safe) before being sold, although there are limits on what they’re allowed to claim they can do. MVA-EL encodes a fusion protein derived from two EBV-associated antigens EBNA1 (EBV Nuclear Antigen 1) and LMP2 (Latent Membrane Protein 2), and it has been designed with the aim to boost T-cell immunity to these antigens. As a result, partial response and stable disease were observed in seven and 14 patients, respectively, for an ORR of 25.9%. 2013;4(2):47–51. Notably, none of the triplet combination regimens analyzed in the above-mentioned study contained taxanes associated with platinum, not solving the question concerning the usefulness of taxanes. See all references for Nasopharyngeal Cancer. Crit Rev Oncol Hematol. 2015;42(3):429–435. Salvage treatment using carbon ion radiation in patients with locoregionally recurrent nasopharyngeal carcinoma: initial results. Nasopharyngeal (nay-zoh-fuh-RIN-jee-ul) carcinoma is cancer that occurs in the nasopharynx, which is located behind your nose and above the back of your throat.Nasopharyngeal carcinoma is rare in the United States. Nasopharyngeal carcinoma. Unfortunately, about 20% of the patients suffer from a radioresistant disease which recurs after upfront therapy. Cooper JS, del Rowe J, Newall J. Dr Sanjay Singh, F Perri,1 G Della Vittoria Scarpati,2 F Caponigro,1 F Ionna,3 F Longo,3 S Buonopane,4 P Muto,4 M Di Marzo,5 S Pisconti,6 R Solla7 1Head and Neck/Sarcoma Medical Oncology Unit, INT IRCCS G Pascale, Naples, Italy; 2Medical Oncology Unit, ASL NA3, Hospital of Pollena Trocchia, Naples, Italy; 3Department of Otolaryngology and Head and Neck Surgery, INT IRCCS G Pascale, Naples, Italy; 4Department of Radiation Therapy, INT IRCCS G Pascale, Naples, Italy; 5Department of Abdominal Surgery, INT IRCCS G Pascale, Naples, Italy; 6Medical Oncology Unit, POC SS Annunziata, Taranto, Italy; 7Italian National Research Council, Institute of Biostructure and Bioimaging, Naples, Italy Abstract: Nasopharyngeal carcinoma is a rare disease in Western countries. 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