CSCO and ASCO Joint Guideline for Recurrent and Metastatic Nasopharyngeal Carcinoma

A joint clinical practice guideline developed by the Chinese Society of Clinical Oncology (CSCO) and the American Society of Clinical Oncology (ASCO) provides evidence-based recommendations for managing recurrent and/or metastatic nasopharyngeal carcinoma (NPC). Based on a systematic literature review encompassing randomized trials, meta-analyses, systematic reviews, prospective and retrospective studies, and multidisciplinary expert consensus, the panel evaluated outcomes including overall survival, progression-free survival, response and disease control rates, toxicity, and quality of life.

For medically fit patients, evidence supports platinum-based chemotherapy combined with a programmed cell death protein 1 (PD-1) inhibitor as preferred first-line therapy, followed by maintenance PD-1 inhibition for up to 2 years. Chemotherapy alone may be offered when immunotherapy is unsuitable or declined. Following disease control with first-line chemotherapy, selected responders may receive oral maintenance chemotherapy or locoregional consolidation intensity-modulated radiotherapy.

For patients with isolated locoregional recurrence amenable to local interventions, salvage surgery or re-irradiation is recommended. Subsequent-line systemic therapy options include chemotherapy, PD-1 inhibitors, and antibody-drug conjugates, with treatment selection individualized according to prior therapy, disease extent, patient fitness, toxicities, drug availability, and local regulatory approvals. The guideline also advises that early supportive and specialist interdisciplinary palliative care accompany active anticancer treatment in advanced, incurable disease.