Nasopharyngeal carcinoma medical therapy: Difference between revisions

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==Overview==
==Overview==
The mainstay of therapy for nasopharyngeal carcinoma is external beam [[radiotherapy]], supplemented in some cases with [[chemotherapy]].
The mainstay of therapy for nasopharyngeal carcinoma is [[external beam radiotherapy]], supplemented in some cases with [[chemotherapy]]. [[Chemotherapy]] drugs that are used in treatment of nasopharyngeal carcinoma are vast, but the two ones which are used more include [[Cisplatin]] and 5-[[Fluorouracil (injection)|Fluorouracil]].


==Medical Therapy==
==Medical Therapy==
The mainstay of therapy for nasopharyngeal carcinoma is external beam [[radiotherapy]].
The mainstay of therapy for nasopharyngeal carcinoma is [[external beam radiotherapy]].<ref name="PastorLopez Pousa2017">{{cite journal|last1=Pastor|first1=M.|last2=Lopez Pousa|first2=A.|last3=del Barco|first3=E.|last4=Perez Segura|first4=P.|last5=Astorga|first5=B. Gonzalez|last6=Castelo|first6=B.|last7=Bonfill|first7=T.|last8=Martinez Trufero|first8=J.|last9=Grau|first9=J. Jose|last10=Mesia|first10=R.|title=SEOM clinical guideline in nasopharynx cancer (2017)|journal=Clinical and Translational Oncology|volume=20|issue=1|year=2017|pages=84–88|issn=1699-048X|doi=10.1007/s12094-017-1777-0}}</ref><ref name="LeeNg2014">{{cite journal|last1=Lee|first1=Anne W.M.|last2=Ng|first2=Wai Tong|last3=Chan|first3=Lucy L.K.|last4=Hung|first4=Wai Man|last5=Chan|first5=Connie C.C.|last6=Sze|first6=Henry C.K.|last7=Chan|first7=Oscar S.H.|last8=Chang|first8=Amy T.Y.|last9=Yeung|first9=Rebecca M.W.|title=Evolution of treatment for nasopharyngeal cancer – Success and setback in the intensity-modulated radiotherapy era|journal=Radiotherapy and Oncology|volume=110|issue=3|year=2014|pages=377–384|issn=01678140|doi=10.1016/j.radonc.2014.02.003}}</ref><ref name="ChuaMa2006">{{cite journal|last1=Chua|first1=Daniel T.T.|last2=Ma|first2=Jun|last3=Sham|first3=Jonathan S.T.|last4=Mai|first4=Hai-Qiang|last5=Choy|first5=Damon T.K.|last6=Hong|first6=Ming-Huang|last7=Lu|first7=Tai-Xiang|last8=Au|first8=Gordon K.H.|last9=Min|first9=Hua-Qing|title=Improvement of survival after addition of induction chemotherapy to radiotherapy in patients with early-stage nasopharyngeal carcinoma: Subgroup analysis of two Phase III trials|journal=International Journal of Radiation Oncology*Biology*Physics|volume=65|issue=5|year=2006|pages=1300–1306|issn=03603016|doi=10.1016/j.ijrobp.2006.02.016}}</ref><ref name="Ribassin-MajedMarguet2017">{{cite journal|last1=Ribassin-Majed|first1=Laureen|last2=Marguet|first2=Sophie|last3=Lee|first3=Anne W.M.|last4=Ng|first4=Wai Tong|last5=Ma|first5=Jun|last6=Chan|first6=Anthony T.C.|last7=Huang|first7=Pei-Yu|last8=Zhu|first8=Guopei|last9=Chua|first9=Daniel T.T.|last10=Chen|first10=Yong|last11=Mai|first11=Hai-Qiang|last12=Kwong|first12=Dora L.W.|last13=Cheah|first13=Shie-Lee|last14=Moon|first14=James|last15=Tung|first15=Yuk|last16=Chi|first16=Kwan-Hwa|last17=Fountzilas|first17=George|last18=Bourhis|first18=Jean|last19=Pignon|first19=Jean Pierre|last20=Blanchard|first20=Pierre|title=What Is the Best Treatment of Locally Advanced Nasopharyngeal Carcinoma? An Individual Patient Data Network Meta-Analysis|journal=Journal of Clinical Oncology|volume=35|issue=5|year=2017|pages=498–505|issn=0732-183X|doi=10.1200/JCO.2016.67.4119}}</ref>
*Standard treatments for patients with nasopharyngeal carcinoma include:<ref>http://www.cancer.gov/types/head-and-neck/hp/nasopharyngeal-treatment-pdq#section/_50</ref>
 
**External beam [[radiation therapy]] alone
**Concurrent chemoradiation followed by adjuvant chemotherapy
**Chemotherapy alone for [[metastatic]] disease
*Undifferentiated subtype of nasopharyngeal carcinoma is highly radiosensitive
===Treatment according to Stages===
===Treatment according to Stages===
{| style="border: 0px; font-size: 90%; margin: 3px; width: 600px" align="center"
{| style="border: 0px; font-size: 90%; margin: 3px; width: 600px" align="center"
Line 22: Line 18:
Stage 1
Stage 1
| style="padding: 5px 5px; background: #F5F5F5;" |
| style="padding: 5px 5px; background: #F5F5F5;" |
*External beam radiation
*[[External beam radiotherapy|External beam radiation]]
|-
|-
| style="padding: 5px 5px; background: #DCDCDC;font-weight: bold" |
| style="padding: 5px 5px; background: #DCDCDC;font-weight: bold" |
Stage 2
Stage 2
| style="padding: 5px 5px; background: #F5F5F5;" |
| style="padding: 5px 5px; background: #F5F5F5;" |
*Chemotherapy given with radiation therapy, followed by more chemotherapy
*[[Chemotherapy]] given with [[radiation therapy]], followed by more [[chemotherapy]]
*Radiation therapy to the tumor and lymph nodes in the neck
*[[Radiation therapy]] to the [[tumor]] and [[lymph nodes]] in the [[neck]]
|-
|-
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold" |
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold" |
Stage 3
Stage 3
| style="padding: 5px 5px; background: #F5F5F5;" |
| style="padding: 5px 5px; background: #F5F5F5;" |
*[[Chemotherapy]] given with radiation therapy, which may be followed by more chemotherapy
*[[Chemotherapy]] given with [[radiation therapy]], which may be followed by more [[chemotherapy]]
*[[Radiation therapy]]
*[[Radiation therapy]]
*Radiation therapy followed by surgery to remove cancer -containing lymph nodes in the neck that remain or come back after radiation therapy
*[[Radiation therapy]] followed by [[surgery]] to remove cancer -containing [[lymph nodes]] in the [[neck]] that remain or come back after [[radiation therapy]]
|-
|-
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold" |
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold" |
Stage 4
Stage 4
| style="padding: 5px 5px; background: #F5F5F5;" |
| style="padding: 5px 5px; background: #F5F5F5;" |
*Chemotherapy given with radiation therapy, followed by more chemotherapy
*[[Chemotherapy]] given with [[radiation therapy]], followed by more [[chemotherapy]]
*Radiation therapy
*[[Radiation therapy]]
*Radiation therapy followed by [[surgery]] to remove cancer -containing lymph nodes in the neck that remain or come back after radiation therapy
*[[Radiation therapy]] followed by [[surgery]] to remove cancer -containing [[lymph nodes]] in the [[neck]] that remain or come back after [[radiation therapy]]
*Chemotherapy for cancer that has metastasized (spread) to other parts of the body
*[[Chemotherapy]] for [[cancer]] that has [[metastasized]] (spread) to other parts of the [[body]]
|-
|-
|}
|}


==Medical Therapy==
==Medical Therapy==
*Pharmacologic medical therapy is recommended among patients with [disease subclass 1], [disease subclass 2], and [disease subclass 3].
*[[Chemotherapy]] drugs that are used in treatment of nasopharyngeal carcinoma are vast, but the two ones which are used more include [[Cisplatin]] and 5-[[Fluorouracil (injection)|Fluorouracil]].
*Pharmacologic medical therapies for [disease name] include (either) [therapy 1], [therapy 2], and/or [therapy 3].
 
*Empiric therapy for [disease name] depends on [disease factor 1] and [disease factor 2].
* '''Cisplatin:'''<ref name="DeckerDrelichman1983">{{cite journal|last1=Decker|first1=David A.|last2=Drelichman|first2=Anibal|last3=Al-Sarraf|first3=Muhyi|last4=Crissman|first4=John|last5=Reed|first5=Melvin L.|title=Chemotherapy for nasopharyngeal carcinoma a ten-year experience|journal=Cancer|volume=52|issue=4|year=1983|pages=602–605|issn=0008-543X|doi=10.1002/1097-0142(19830815)52:4<602::AID-CNCR2820520404>3.0.CO;2-6}}</ref><ref>{{Cite journal
*Patients with [disease subclass 1] are treated with [therapy 1], whereas patients with [disease subclass 2] are treated with [therapy 2].
| author = [[K. Al-Kourainy]], [[J. Crissman]], [[J. Ensley]], [[J. Kish]], [[J. Kelly]] & [[M. Al-Sarraf]]
===Disease Name===
| title = Excellent response to cis-platinum-based chemotherapy in patients with recurrent or previously untreated advanced nasopharyngeal carcinoma
*'''1 Stage 1 - Name of stage'''
| journal = [[American journal of clinical oncology]]
**1.1 '''Specific Organ system involved 1'''
| volume = 11
***1.1.1 '''Adult'''
| issue = 4
****Preferred regimen (1): [[drug name]] 100 mg PO q12h for 10-21 days '''(Contraindications/specific instructions)'''
| pages = 427–430
****Preferred regimen (2): [[drug name]] 500 mg PO q8h for 14-21 days
| year = 1988
****Preferred regimen (3): [[drug name]] 500 mg q12h for 14-21 days
| month = August
****Alternative regimen (1): [[drug name]] 500 mg PO q6h for 7–10 days
| pmid = 2457306
****Alternative regimen (2): [[drug name]] 500 mg PO q12h for 14–21 days
}}</ref>
****Alternative regimen (3): [[drug name]] 500 mg PO q6h for 14–21 days
** Preferred regimen: 80-100 mg/m<sup>2</sup>  slow [[Intravenous therapy|IV]] with enough [[hydration]]. Repeat every 3 weeks.
***1.1.2 '''Pediatric'''
** [[Contraindications]]:
****1.1.2.1 (Specific population e.g. '''children < 8 years of age''')
*** [[Hypersensitivity]] to [[platinum]]-containing compounds
*****Preferred regimen (1): [[drug name]] 50 mg/kg PO per day q8h (maximum, 500 mg per dose)
*** [[Renal function impairment]]
*****Preferred regimen (2): [[drug name]] 30 mg/kg PO per day in 2 divided doses (maximum, 500 mg per dose)
*** [[Hearing impairment]]  
*****Alternative regimen (1): [[drug name]]10 mg/kg PO q6h (maximum, 500 mg per day)
*** Myelosuppressed [[patients]]
*****Alternative regimen (2): [[drug name]] 7.5 mg/kg PO q12h (maximum, 500 mg per dose)
*** Nursing or [[pregnant]] women
*****Alternative regimen (3): [[drug name]] 12.5 mg/kg PO q6h (maximum, 500 mg per dose)
** [[Adverse effect (medicine)|Side effects]]:
****1.1.2.2 (Specific population e.g. '<nowiki/>'''''children < 8 years of age'''''')
*** [[Nephrotoxicity]]  
*****Preferred regimen (1): [[drug name]] 4 mg/kg/day PO q12h（maximum, 100 mg per dose）
*** [[Ototoxicity]]
*****Alternative regimen (1): [[drug name]] 10 mg/kg PO q6h (maximum, 500 mg per day)
*** [[Myelosuppression]]
*****Alternative regimen (2): [[drug name]] 7.5 mg/kg PO q12h (maximum, 500 mg per dose)
*** [[Gastrointestinal]] problems like [[Acute (medicine)|acute]] and delayed [[nausea and vomiting]] and [[diarrhea]]  
*****Alternative regimen (3): [[drug name]] 12.5 mg/kg PO q6h (maximum, 500 mg per dose)
*** [[Electrolyte disturbance]]:
**1.2 '''Specific Organ system involved 2'''
**** [[Hypomagnesemia]]
***1.2.1 '''Adult'''
**** [[Hypocalcemia]]
****Preferred regimen (1): [[drug name]] 500 mg PO q8h
**** [[Hyponatremia]]
***1.2.2  '''Pediatric'''
**** [[Hypokalemia]]  
****Preferred regimen (1): [[drug name]] 50 mg/kg/day PO q8h (maximum, 500 mg per dose)
**** [[Hypophosphatemia]]  
*** [[Irreversible]] [[paresthesias]]
*** [[Anaphylaxis]]
'''Note (1):''' [[Urine output]] should be maintain more than 100-150 ml/ hr.
 
'''Note (2):''' [[Antiemetic|Anti-emetic]] treatment should be done in all [[patients]].
 
* '''5-Fluorouracil:'''<ref name="Al-Sarraf1987">{{cite journal|last1=Al-Sarraf|first1=Muhyi|title=Chemotherapeutic management of head and neck cancer|journal=Cancer and Metastasis Review|volume=6|issue=3|year=1987|pages=181–198|issn=0167-7659|doi=10.1007/BF00144263}}</ref><ref>{{Cite journal
| author = [[M. Al-Sarraf]]
| title = Head and neck cancer: chemotherapy concepts
| journal = [[Seminars in oncology]]
| volume = 15
| issue = 1
| pages = 70–85
| year = 1988
| month = February
| pmid = 3278391
}}</ref>
** Preferred regimen: 1000 mg/m<sup>2</sup>/day [[Intravenous therapy|IV]] [[infusion]] for 4-5 days and repeated every 3 weeks.
** [[Contraindications]]:
*** [[Hypersensitivity]]
*** [[Liver diseases]]
*** [[Renal function impairment]]  
*** Myelosuppressed patients
*** [[Unstable angina]]
** [[Adverse effect (medicine)|Side effects]]:
*** [[Myelosuppression]]
*** [[Gastrointestinal]] problems like [[nausea and vomiting]] and [[diarrhea]]
*** [[Mucositis]]
*** [[Angina]]
*** Alopecia
*** [[Hand-foot syndrome]]
'''Note (1):''' In [[patients]] with [[liver diseases]] [[dose]] reduction should be considered.
 
'''Note (2):''' Using this drug in familial pyrimidenemia [[patients]] can cause fatal [[neurotoxicity]].


*2 '''Stage 2 - Name of stage'''
**2.1 '''Specific Organ system involved 1 '''
**:'''Note (1):'''
**:'''Note (2)''':
**:'''Note (3):'''
***2.1.1 '''Adult'''
****Parenteral regimen
*****Preferred regimen (1): [[drug name]] 2 g IV q24h for 14 (14–21) days
*****Alternative regimen (1): [[drug name]] 2 g IV q8h for 14 (14–21) days
*****Alternative regimen (2): [[drug name]] 18–24 MU/day IV q4h for 14 (14–21) days
****Oral regimen
*****Preferred regimen (1): [[drug name]] 500 mg PO q8h for 14 (14–21) days
*****Preferred regimen (2): [[drug name]] 100 mg PO q12h for 14 (14–21) days
*****Preferred regimen (3): [[drug name]] 500 mg PO q12h for 14 (14–21) days
*****Alternative regimen (1): [[drug name]] 500 mg PO q6h for 7–10 days
*****Alternative regimen (2): [[drug name]] 500 mg PO q12h for 14–21 days
*****Alternative regimen (3):[[drug name]] 500 mg PO q6h for 14–21 days
***2.1.2 '''Pediatric'''
****Parenteral regimen
*****Preferred regimen (1): [[drug name]] 50–75 mg/kg IV q24h for 14 (14–21) days (maximum, 2 g)
*****Alternative regimen (1): [[drug name]] 150–200 mg/kg/day IV q6–8h for 14 (14–21) days (maximum, 6 g per day)
*****Alternative regimen (2):  [[drug name]] 200,000–400,000 U/kg/day IV q4h for 14 (14–21) days (maximum, 18–24 million U per day) '<nowiki/>'''''(Contraindications/specific instructions)''''''
****Oral regimen
*****Preferred regimen (1):  [[drug name]] 50 mg/kg/day PO q8h for 14 (14–21) days  (maximum, 500 mg per dose)
*****Preferred regimen (2): [[drug name]] '''(for children aged ≥ 8 years)''' 4 mg/kg/day PO q12h for 14 (14–21) days (maximum, 100 mg per dose)
*****Preferred regimen (3): [[drug name]] 30 mg/kg/day PO q12h for 14 (14–21) days  (maximum, 500 mg per dose)
*****Alternative regimen (1):  [[drug name]] 10 mg/kg PO q6h 7–10 days  (maximum, 500 mg per day)
*****Alternative regimen (2): [[drug name]] 7.5 mg/kg PO q12h for 14–21 days  (maximum, 500 mg per dose)
*****Alternative regimen (3): [[drug name]] 12.5 mg/kg PO q6h for 14–21 days  (maximum,500 mg per dose)
**2.2  '<nowiki/>'''''Other Organ system involved 2''''''
**:'''Note (1):'''
**:'''Note (2)''':
**:'''Note (3):'''
***2.2.1 '''Adult'''
****Parenteral regimen
*****Preferred regimen (1): [[drug name]] 2 g IV q24h for 14 (14–21) days
*****Alternative regimen (1): [[drug name]] 2 g IV q8h for 14 (14–21) days
*****Alternative regimen (2): [[drug name]] 18–24 MU/day IV q4h for 14 (14–21) days
****Oral regimen
*****Preferred regimen (1): [[drug name]] 500 mg PO q8h for 14 (14–21) days
*****Preferred regimen (2): [[drug name]] 100 mg PO q12h for 14 (14–21) days
*****Preferred regimen (3): [[drug name]] 500 mg PO q12h for 14 (14–21) days
*****Alternative regimen (1): [[drug name]] 500 mg PO q6h for 7–10 days
*****Alternative regimen (2): [[drug name]] 500 mg PO q12h for 14–21 days
*****Alternative regimen (3):[[drug name]] 500 mg PO q6h for 14–21 days
***2.2.2 '''Pediatric'''
****Parenteral regimen
*****Preferred regimen (1): [[drug name]] 50–75 mg/kg IV q24h for 14 (14–21) days (maximum, 2 g)
*****Alternative regimen (1): [[drug name]] 150–200 mg/kg/day IV q6–8h for 14 (14–21) days (maximum, 6 g per day)
*****Alternative regimen (2):  [[drug name]] 200,000–400,000 U/kg/day IV q4h for 14 (14–21) days (maximum, 18–24 million U per day)
****Oral regimen
*****Preferred regimen (1):  [[drug name]] 50 mg/kg/day PO q8h for 14 (14–21) days  (maximum, 500 mg per dose)
*****Preferred regimen (2): [[drug name]] 4 mg/kg/day PO q12h for 14 (14–21) days (maximum, 100 mg per dose)
*****Preferred regimen (3): [[drug name]] 30 mg/kg/day PO q12h for 14 (14–21) days  (maximum, 500 mg per dose)
*****Alternative regimen (1):  [[drug name]] 10 mg/kg PO q6h 7–10 days  (maximum, 500 mg per day)
*****Alternative regimen (2): [[drug name]] 7.5 mg/kg PO q12h for 14–21 days  (maximum, 500 mg per dose)
*****Alternative regimen (3): [[drug name]] 12.5 mg/kg PO q6h for 14–21 days  (maximum,500 mg per dose)
==References==
==References==
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{{Reflist|2}}
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Latest revision as of 22:53, 29 July 2020

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Homa Najafi, M.D.[2]Faizan Sheraz, M.D. [3]

Overview

The mainstay of therapy for nasopharyngeal carcinoma is external beam radiotherapy, supplemented in some cases with chemotherapy. Chemotherapy drugs that are used in treatment of nasopharyngeal carcinoma are vast, but the two ones which are used more include Cisplatin and 5-Fluorouracil.

Medical Therapy

The mainstay of therapy for nasopharyngeal carcinoma is external beam radiotherapy.[1][2][3][4]

Treatment according to Stages
Stage Treatment

Stage 1

Stage 2

Stage 3

Stage 4

Medical Therapy

Note (1): Urine output should be maintain more than 100-150 ml/ hr.

Note (2): Anti-emetic treatment should be done in all patients.

Note (1): In patients with liver diseases dose reduction should be considered.

Note (2): Using this drug in familial pyrimidenemia patients can cause fatal neurotoxicity.

References

  1. ↑ Pastor, M.; Lopez Pousa, A.; del Barco, E.; Perez Segura, P.; Astorga, B. Gonzalez; Castelo, B.; Bonfill, T.; Martinez Trufero, J.; Grau, J. Jose; Mesia, R. (2017). "SEOM clinical guideline in nasopharynx cancer (2017)". Clinical and Translational Oncology. 20 (1): 84–88. doi:10.1007/s12094-017-1777-0. ISSN 1699-048X.
  2. ↑ Lee, Anne W.M.; Ng, Wai Tong; Chan, Lucy L.K.; Hung, Wai Man; Chan, Connie C.C.; Sze, Henry C.K.; Chan, Oscar S.H.; Chang, Amy T.Y.; Yeung, Rebecca M.W. (2014). "Evolution of treatment for nasopharyngeal cancer – Success and setback in the intensity-modulated radiotherapy era". Radiotherapy and Oncology. 110 (3): 377–384. doi:10.1016/j.radonc.2014.02.003. ISSN 0167-8140.
  3. ↑ Chua, Daniel T.T.; Ma, Jun; Sham, Jonathan S.T.; Mai, Hai-Qiang; Choy, Damon T.K.; Hong, Ming-Huang; Lu, Tai-Xiang; Au, Gordon K.H.; Min, Hua-Qing (2006). "Improvement of survival after addition of induction chemotherapy to radiotherapy in patients with early-stage nasopharyngeal carcinoma: Subgroup analysis of two Phase III trials". International Journal of Radiation Oncology*Biology*Physics. 65 (5): 1300–1306. doi:10.1016/j.ijrobp.2006.02.016. ISSN 0360-3016.
  4. ↑ Ribassin-Majed, Laureen; Marguet, Sophie; Lee, Anne W.M.; Ng, Wai Tong; Ma, Jun; Chan, Anthony T.C.; Huang, Pei-Yu; Zhu, Guopei; Chua, Daniel T.T.; Chen, Yong; Mai, Hai-Qiang; Kwong, Dora L.W.; Cheah, Shie-Lee; Moon, James; Tung, Yuk; Chi, Kwan-Hwa; Fountzilas, George; Bourhis, Jean; Pignon, Jean Pierre; Blanchard, Pierre (2017). "What Is the Best Treatment of Locally Advanced Nasopharyngeal Carcinoma? An Individual Patient Data Network Meta-Analysis". Journal of Clinical Oncology. 35 (5): 498–505. doi:10.1200/JCO.2016.67.4119. ISSN 0732-183X.
  5. ↑ Decker, David A.; Drelichman, Anibal; Al-Sarraf, Muhyi; Crissman, John; Reed, Melvin L. (1983). "Chemotherapy for nasopharyngeal carcinoma a ten-year experience". Cancer. 52 (4): 602–605. doi:10.1002/1097-0142(19830815)52:4<602::AID-CNCR2820520404>3.0.CO;2-6. ISSN 0008-543X.
  6. ↑ K. Al-Kourainy, J. Crissman, J. Ensley, J. Kish, J. Kelly & M. Al-Sarraf (1988). "Excellent response to cis-platinum-based chemotherapy in patients with recurrent or previously untreated advanced nasopharyngeal carcinoma". American journal of clinical oncology. 11 (4): 427–430. PMID 2457306. Unknown parameter |month= ignored (help)
  7. ↑ Al-Sarraf, Muhyi (1987). "Chemotherapeutic management of head and neck cancer". Cancer and Metastasis Review. 6 (3): 181–198. doi:10.1007/BF00144263. ISSN 0167-7659.
  8. ↑ M. Al-Sarraf (1988). "Head and neck cancer: chemotherapy concepts". Seminars in oncology. 15 (1): 70–85. PMID 3278391. Unknown parameter |month= ignored (help)

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