NCCN Guidelines
NCCN Guideline Updates 1.2025
SYSTEMIC THERAPY FOR NASOPHARYNGEAL CANCER(1)
• The choice of systemic therapy must be individualized based on the patient's characteristics.
• Use NGS profiling and other appropriate biomarker tests to test for at least CPS and TMB prior to treatment (category 2B).
• These guidelines are based on clinical trial data and are tailored to patient characteristics such as performance status (PS) and goals of therapy.
Induction/Sequential Therapy
Preferred Regimes:
Gemcitabine/cisplatin: Category 1 for EBV-associated disease, category 2A for non-EBV-associated disease.
Docetaxel/cisplatin/5-FU (dose-adjusted): Category 1 for EBV-associated disease, category 2A for non-EBV-associated disease.
Other Recommended Regimes:
Cisplatin/5-FU Docetaxel/cisplatin: Category 2B.
Useful in special circumstances:
For M1 oligometastatic disease (PS 0–1), capecitabine maintenance without concomitant RT after induction chemotherapy is an option.
After induction, agents used with concomitant systemic therapy/RT
typically include weekly cisplatin or carboplatin.
Systemic Therapy/RT Followed by Adjuvant Chemotherapy
Preferred Regimes:
Cisplatin + RT followed by cisplatin/5-FU
Other Recommended Regimes:
Cisplatin + RT followed by carboplatin/5-FU
Cisplatin + RT without adjuvant chemotherapy
Useful in Special Circumstances:
If ineligible or intolerant to cisplatin, carboplatin may be used as an alternative: Carboplatin + RT followed by carboplatin/5-FU
Cisplatin + RT followed by capecitabine ± induction chemotherapy: For EBV-associated disease (for T4, N1–3 or any T, N2–3)
Reirradiation + Concomitant systemic therapy
Recommended regimens:
Platinum-based regimens (e.g. cisplatin or carboplatin, if cisplatin is ineligible or in cases of intolerance).
Recurrent, Unresectable, Oligometastatic or Metastatic Disease (no option for surgery or RT)
Preferred Regimes:
-
1st line - Cisplatin/gemcitabine + toripalimab: Category 1.
-
Subsequent lines - toripalimab - if disease progresses during or after platinum therapy
Other Recommended Regimes:
1st line - Combined therapies
-
Cisplatin/gemcitabine: Category 1
-
Cisplatin/gemcitabine + tislelizumab: Category 2B
-
Cisplatin/gemcitabine + another PD-1 inhibitor (e.g., pembrolizumab or nivolumab)
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Cisplatin/5-FU
-
Cisplatin or carboplatin/docetaxel or paclitaxel
-
Carboplatin/cetuximab
-
Gemcitabine/carboplatin
1st line - Single agents
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Cisplatin
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Carboplatin
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Paclitaxel
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Docetaxel
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5-FU
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Methotrexate
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Gemcitabine
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Capecitabine
Recurrent, Unresectable, Oligometastatic or Metastatic Disease (no option for surgery or RT)
Preferred Regimes:
-
1st line - Cisplatin/gemcitabine + toripalimab: Category 1.
-
Subsequent lines - toripalimab - if disease progresses during or after platinum therapy
Other Recommended Regimes:
Subsequent line (Immunotherapy)
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Nivolumab: If previously treated, recurrent or metastatic non-keratinizing disease (category 2B).
-
Pembrolizumab: If previously treated, PDL1-positive recurrent or metastatic disease (category 2B).
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Tislelizumab: Category 2B.
Useful in special circumstances (Subsequent line):
-
Pembrolizumab: For tumors with high mutational burden [TMB-H] [≥10mut/Mb]
NCCN - Alliance of Leading Cancer Centers (National Comprehensive Cancer Network); NGS - Next Generation Sequencing; CPS - Combined Positive Score ; TMB - Tumor mutational burden; EBV - Epstein–Barr Virus; RT - Radiotherapy; 5-FU - 5 - Fluorouracil
To view the full NCCN Guidelines 2025.1, CLICK HERE or contact Dr. Reddy's for further guidance.