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NCCN Guidelines

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)

  • Cisplatin/5-FU

  • Cisplatin or carboplatin/docetaxel or paclitaxel

  • Carboplatin/cetuximab

  • Gemcitabine/carboplatin


1st line - Single agents

  • Cisplatin

  • Carboplatin

  • Paclitaxel

  • Docetaxel

  • 5-FU

  • Methotrexate

  • Gemcitabine

  • 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)

  • Nivolumab: If previously treated, recurrent or metastatic non-keratinizing disease (category 2B).

  • Pembrolizumab: If previously treated, PDL1-positive recurrent or metastatic disease (category 2B).

  • 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.

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