Treatment of Recurrent and/or Metastatic Nasopharyngeal Carcinoma: CSCO and ASCO Joint Guideline

PURPOSE To provide evidence-based recommendations on first- and subsequent-line systemic therapy, maintenance therapy, locoregional consolidation, and salvage local therapy for patients with recurrent and/or metastatic nasopharyngeal carcinoma (NPC). METHODS A multidisciplinary Expert Panel convened by CSCO and ASCO reviewed evidence from randomized trials, meta-analyses, systematic reviews, prospective and retrospective studies, and clinical experience. The guideline was informed by a systematic literature review and consensus-based interpretation of efficacy, safety, feasibility, and patient-centered outcomes across scenarios. Outcomes included overall and progression-free survival, response and disease control rates, toxicity, and quality of life. RESULTS Evidence supports platinum-based chemotherapy plus a programmed cell death protein 1 (PD-1) inhibitor as preferred first-line therapy for medically fit patients. Evidence also supports maintenance strategies after disease control, while treatment selection depends on prior treatment, disease extent, patient fitness, resource availability, and preferences. Selected responders may receive locoregional consolidation radiotherapy or oral maintenance chemotherapy. For isolated locoregional recurrence amenable to local therapy, options include salvage surgery and re-irradiation. RECOMMENDATIONS Chemotherapy plus a PD-1 inhibitor, followed by maintenance PD-1 inhibition for up to 2 years, should be offered first-line to appropriate patients with recurrent and/or metastatic NPC. Chemotherapy alone may be offered when immunotherapy is unsuitable or declined. Selected patients responding to first-line chemotherapy may receive oral maintenance chemotherapy or locoregional consolidation intensity-modulated radiotherapy. Salvage surgery or re-irradiation is recommended for appropriately selected patients with isolated locoregional recurrence. Subsequent-line options include chemotherapy, PD-1 inhibitors, and antibody-drug conjugates. Treatment should be individualized according to disease setting, prior therapy, expected toxicities, availability, local drug approvals, and patient preferences. Early supportive and specialist interdisciplinary palliative care, where available, should accompany active anticancer treatment for advanced, incurable disease. Additional information is available at www.ascopubs.org/topics/asco-guidelines/head-neck-cancer .