Targeted Therapy for Nasopharyngeal Cancer: Efficacy and Prognosis

Can nasopharyngeal carcinoma be treated with targeted therapy?

Hello Dr.
Chen: Recently, a friend of mine was diagnosed with nasopharyngeal carcinoma, and the pathology report indicates it is stage II.
Aside from a hard mass in the neck measuring about 3 cm, there are no other clinical symptoms.
I would like to ask you: 1.
What is the cure rate and prognosis for nasopharyngeal carcinoma? How often should follow-up be conducted after treatment, and for how long? 2.
What is targeted therapy? Is it applicable to nasopharyngeal carcinoma? Are there any side effects? 3.
Does the use of targeted therapy for nasopharyngeal carcinoma improve the cure rate? Are there many cases of targeted therapy for nasopharyngeal carcinoma in the country? What are the cure rates and prognosis? Thank you for your assistance!

Ms. Chen, 20~29 year old female. Ask Date: 2008/02/04

Dr. Chen Sirong reply Oncology

1.
Due to the high sensitivity of nasopharyngeal carcinoma cells to radiation, radiation therapy has been the primary treatment for nasopharyngeal carcinoma.
While radiation therapy can effectively control local tumor cells, nasopharyngeal carcinoma is prone to metastasis; therefore, physicians often combine it with chemotherapy to increase the cure rate.
Additionally, the location of nasopharyngeal carcinoma is near the skull base, where many important blood vessels and nerves pass, and it is very likely to metastasize to the cervical lymph nodes, making it difficult to completely surgically remove the tumor.
The best chance for treatment of nasopharyngeal carcinoma is during the initial therapy, as nasopharyngeal carcinoma cells respond exceptionally well to radiation therapy, with early cure rates exceeding 90%.
The entire radiation treatment duration is approximately two months, with the radiation field extending from the skull base to the apex of the lungs.
2.
There is currently no targeted therapy for nasopharyngeal carcinoma, and the control rate of targeted new drugs is about 30%, not 100%, and this refers to controlling tumor growth rather than cure rates.
The new drug cetuximab (Erbitux) utilizes monoclonal antibodies to block epidermal growth factor receptor signaling in head and neck cancer cells, leading to apoptosis of cancer cells.
According to a report in the New England Journal of Medicine in February 2006 by Dr.
Bonner in the U.S., the average survival time for 424 patients with advanced head and neck cancer treated with cetuximab combined with radiation therapy was 49 months, compared to 29 months for those receiving radiation therapy alone.
Another targeted oral medication is gefitinib (Iressa), which is commonly used for lung cancer and may provide some partial efficacy in patients with head and neck cancers.
However, it is important to note that it is not used for nasopharyngeal carcinoma but rather for advanced other head and neck cancers, as the treatment success rate for nasopharyngeal carcinoma is very high.
Very few patients fail to respond to initial treatment; rather, a small percentage may experience recurrence within 2-3 years, and those who relapse after three years are less than 3%.
Therefore, patients can feel reassured and continue with their current treatment.

Reply Date: 2008/02/04

More Info

Nasopharyngeal cancer (NPC) is a type of cancer that originates in the nasopharynx, the area behind the nose and above the back of the throat. It is particularly prevalent in certain regions, such as Southeast Asia, and is often associated with the Epstein-Barr virus (EBV). Given your friend's diagnosis of stage II NPC, it's essential to understand the treatment options, prognosis, and the role of targeted therapy in managing this condition.

1. Cure Rates and Prognosis: The prognosis for NPC is generally favorable, especially in the early stages. For stage II NPC, the overall 5-year survival rate can exceed 90% with appropriate treatment, which typically involves a combination of radiation therapy and chemotherapy. Radiation therapy is particularly effective due to the cancer's sensitivity to radiation. After initial treatment, follow-up is crucial. Generally, patients are monitored every 3 to 6 months for the first 2 to 3 years, then annually thereafter, depending on the individual case and the physician's recommendations. This follow-up includes physical examinations and imaging studies to detect any recurrence early.

2. What is Targeted Therapy?: Targeted therapy refers to drugs that specifically target cancer cells' unique characteristics, such as specific genes or proteins involved in the growth and survival of cancer. Unlike traditional chemotherapy, which affects all rapidly dividing cells, targeted therapies aim to minimize damage to normal cells. In the context of NPC, targeted therapies may include monoclonal antibodies that target specific pathways involved in tumor growth. However, the use of targeted therapy in NPC is still under investigation, and its application may vary based on individual patient factors.

3. Efficacy of Targeted Therapy in NPC: While targeted therapies have shown promise in various cancers, their role in NPC is still being explored. Current research indicates that certain targeted therapies, such as those that inhibit the epidermal growth factor receptor (EGFR), may be beneficial, particularly in recurrent or metastatic cases. However, the overall cure rates for NPC primarily rely on conventional treatments like radiation and chemotherapy. The integration of targeted therapy may enhance treatment outcomes, but it is not yet a standard part of the initial treatment regimen for localized NPC. In terms of case numbers, the use of targeted therapy in NPC is not as widespread as in other cancers, and ongoing clinical trials are essential to establish its efficacy and safety.

In conclusion, your friend's prognosis appears favorable given the early stage of NPC. The combination of radiation and chemotherapy remains the cornerstone of treatment, with regular follow-ups to monitor for recurrence. While targeted therapy is an exciting area of research, its role in NPC is still evolving, and it is essential to discuss all treatment options with a healthcare provider to determine the best course of action tailored to the patient's specific situation.

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