Nasopharyngeal Cancer Treatment Protocols 

Updated: Apr 22, 2016
  • Author: Marvaretta M Stevenson, MD; Chief Editor: Guy J Petruzzelli, MD, PhD, MBA, FACS  more...
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Treatment Protocols

Treatment protocols for nasopharyngeal cancers are provided below, including generalized first-line therapy based on stage; chemoradiation therapy and induction chemotherapy for locally advanced disease; and first-, second-, and third-line chemotherapy for metastatic or recurrent disease. [1, 2, 3]

Generalized treatment recommendations for nasopharyngeal cancers

See the list below:

  • Treatment plans for all disease stages should be discussed at a multidisciplinary tumor conference involving ear, nose, throat (ENT) surgeons; radiation oncologists; and medical oncologists
  • Selected patients with advanced or metastatic disease may receive additional therapy (radiation or neck dissection) depending on their response to first-line therapy
  • Surgery at the primary disease site has a very limited role, if any, in nasopharyngeal cancers

Radiation therapy for early or localized nasopharyngeal cancers

Stage I:

  • Patients with early or localized disease may be treated with definitive radiation therapy to the nasopharynx alone
  • Radiation doses of 66-70 Gy (2.0 Gy/fraction; daily Monday-Friday in 7wk)

Chemotherapy with radiation therapy for locally advanced nasopharyngeal cancers

Stages II-IVB:

  • Patients with stage II-IVB nasopharyngeal cancers are treated with concurrent chemotherapy and radiation +/- adjuvant chemotherapy or with induction chemotherapy followed by concurrent chemoradiation

Acceptable chemotherapy regimens for advanced nasopharyngeal cancers (stages II-IVB):

  • Cisplatin 100 mg/m 2 IV on days 1, 22, and 43 with radiation +/- adjuvant chemotherapy with cisplatin 80 mg/m 2 IV on day 1 plus  fluorouracil (5-FU) 1000 mg/m 2/day by continuous IV infusion on days 1-4 every 4wk for 3 cycles [4, 5, 6] or
  • Carboplatin AUC 6 IV every 3 weeks for 3 cycles with radiation +/- adjuvant chemotherapy with carboplatin AUC 5 IV on day 1 plus  fluorouracil (5-FU) 1000 mg/m 2/day by continuous IV infusion on days 1-4 every 3 weeks for 2 cycles [7]
  • Radiation doses during concurrent chemoradiation are up to 70 Gy (2.0 Gy/fraction)
  • Induction chemotherapy with docetaxel 70 mg/m 2 IV on day 1 plus  cisplatin 75 mg/m 2 IV on day 1 plus  5-FU 1000 mg/m 2/day by continuous IV infusion on days 1-4 for three cycles followed by concurrent chemoradiation with cisplatin 100 mg/m 2 IV on days 1, 22, and 43  [8]

First-line chemotherapy for metastatic or recurrent nasopharyngeal cancers

Stage IVC:

  • Patients with metastatic nasopharyngeal cancers or recurrent disease (after first-line therapy) are treated with standard platinum-based chemotherapies
  • Single agents can be used if patients cannot tolerate platinum-based agents [9, 10]

Acceptable chemotherapy regimens in patients with metastatic, progressing, or recurrent nasopharyngeal cancers (unless otherwise stated, goal is to complete 4-6 cycles):

  • Cisplatin 75 mg/m 2 IV on day 1 plus  docetaxel 75 mg/m 2 IV on day 1 every 3wk [11, 12, 13] or
  • Cisplatin 75 mg/m 2 IV on day 1 plus  paclitaxel 175 mg/m 2 IV on day 1 every 3wk [14, 15] or
  • Carboplatin area under the curve (AUC; see the Carboplatin AUC Dose Calculation [Calvert formula] calculator) 6 IV on day 1 plus  docetaxel 65 mg/m 2 IV on day 1 every 3wk [16] or
  • Carboplatin AUC 6 IV on day 1 plus  paclitaxel 200 mg/m 2 IV on day 1 every 3wk [17, 18, 19] or
  • Cisplatin 100 mg/m 2 IV on day 1 plus  5-FU 1000 mg/m 2/day by continuous IV infusion on days 1-4 every 3wk [20, 15, 21, 22, 23] or
  • Cisplatin 50-70 mg/m 2 IV on day 1 plus  gemcitabine 1000 mg/m 2 IV on days 1, 8, and 15 every 4wk [24, 25] or
  • Cetuximab 400 mg/m 2 IV on day 1 followed by 250 mg/m 2 IV weekly plus  carboplatin AUC 5 IV every 3 weeks for up to 8 cycles [26] or 
  • Gemcitabine 1000 mg/m 2 IV plus  vinorelbine 25 mg/m 2 IV on days 1 and 8 every 21 days [27] or
  • Gemcitabine 1000 mg/m 2 IV on days 1, 8, and 15 every 4wk [24, 28] or
  • Gemcitabine 1250 mg/m 2 IV on days 1 and 8 every 3wk [29] or
  • Methotrexate 40 mg/m 2 IV weekly (3wk equals 1 cycle) [10, 20] or
  • Paclitaxel 200 mg/m 2 IV every 3wk [30] or
  • Docetaxel 75 mg/m 2 IV every 3wk [31, 32, 33, 34, 35]

Second- and third-line chemotherapy for metastatic or recurrent nasopharyngeal cancers

Stage IVC:

  • Second-line chemotherapy is given after disease progression or recurrence following completion of first-line therapy
  • Third-line therapies are given after disease progression or recurrence following completion of first- and second-line therapies
  • Second- and third-line regimens are similar to regimens used as first-line therapy but usually offer lower response rates and survival benefits
  • Patients should be treated with platinum-based chemotherapies if they have not previously received a platinum-based drug
  • Some regimens are typically used in head and neck cancers in general, and others have been specifically studied in nasopharyngeal cancer [9, 10]

Acceptable chemotherapy regimens in patients with metastastic, progressing or recurrent nasopharyngeal cancers after completion of first-line therapy:

  • Cisplatin 75 mg/m 2 IV on day 1 plus  docetaxel 75 mg/m 2 IV on day 1 every 3wk [11] or
  • Cisplatin 75 mg/m 2 IV on day 1 plus  paclitaxel 175 mg/m 2 IV on day 1 every 3wk [14, 15] or
  • Carboplatin AUC 6 IV on day 1 plus  docetaxel 65 mg/m 2 IV on day 1 every 3wk [16] or
  • Carboplatin AUC 6 IV on day 1 plus  paclitaxel 200 mg/m 2 IV on day 1 every 3wk [17, 19, 36] or
  • Cisplatin 100 mg/m 2 IV on day 1 plus  5-FU 1000 mg/m 2/day by continuous IV infusion on days 1-4 every 3wk [20, 15, 21, 22, 23] or
  • Cisplatin 50-70 mg/m 2 IV on day 1 plus  gemcitabine 1000 mg/m 2 IV on days 1, 8, and 15 every 4wk [24, 25] or
  • Cetuximab 400 mg/m 2 IV on day 1 followed by 250 mg/m 2 IV weekly plus  carboplatin AUC 5 IV every 3 weeks for up to 8 cycles [26] or 
  • Gemcitabine 1000 mg/m 2 IV plus  vinorelbine 25 mg/m 2 IV on days 1 and 8 every 21 days [27] or
  • Gemcitabine 1000 mg/m 2 IV on days 1, 8, and 15 every 4wk or
  • Gemcitabine 1250 mg/m 2 IV on days 1 and 8 every 3wk [24, 28] or
  • Methotrexate 40 mg/m 2 IV weekly (3wk equals 1 cycle) or
  • Paclitaxel 200 mg/m 2 IV every 3wk [30] or
  • Docetaxel 75 mg/m 2 IV every 3wk [31, 32, 33, 34, 35]