Nasopharyngeal carcinoma medical therapy

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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.

Medical Therapy

The mainstay of therapy for nasopharyngeal carcinoma is external beam radiotherapy.

• Standard treatments for patients with nasopharyngeal carcinoma include:
  • 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

Stage	Treatment
Stage 1	External beam radiation
Stage 2	Chemotherapy given with radiation therapy, followed by more chemotherapy Radiation therapy to the tumor and lymph nodes in the neck
Stage 3	Chemotherapy given with radiation therapy, which may be followed by more chemotherapy Radiation therapy Radiation therapy followed by surgery to remove cancer -containing lymph nodes in the neck that remain or come back after radiation therapy
Stage 4	Chemotherapy given with radiation therapy, followed by more chemotherapy 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

Medical Therapy

• Pharmacologic medical therapies for nasopharyngeal carcinoma include Cisplatin and 5-Fluorouracil.

• Cisplatin:
  • Preferred regimen: 80- 100 mg/m² slow IV with enough hydration.Repeat every 3 weeks
  • Contraindications:
    • Hypersensitivity to platinum-containing compounds
    • Renal function impairment
    • Hearing impairment
    • Myelosuppressed patients
    • Nursing or pregnant women
  • Side effects:
    • Nephrotoxicity
    • Ototoxicity
    • Myelosuppression
    • Gastrointestinal problems like acute and delayed nausea and vomiting and diarrhea
    • Electrolyte disturbance:
      • Hypomagnesemia
      • Hypocalcemia
      • Hyponatremia
      • Hypokalemia
      • Hypophosphatemia
    • Irreversible paresthesias
    • Anaphylaxis

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

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

• 5-Fluorouracil:
  • Preferred regimen: 1000 mg/m²/day IV infusion for 4-5 days and repeated every 3 weeks.
  • Contraindications:
    • Hypersensitivity
    • Liver diseases
    • Renal function impairment
    • Myelosuppressed patients
    • myelosuppression
    • Unstable angina
  • Side effects:
    • Myelosuppression
    • Gastrointestinal problems like nausea and vomiting and diarrhea
    • Mucositis
    • Angina
    • Alopecia
    • Hand-foot syndrome

• Main drug interactions: Not compatible with diazepam and droperidol.

• Main side effects: Myelosuppression, dose-dependent nausea and vomiting, mucositis, angina, alopecia, hand-foot syndrome, and diarrhea.

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

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