Nasopharyngeal carcinoma (NPC) has several features that differ according to geographic area. For example, age distribution differs in low-incidence areas compared with endemic areas. In low-incidence areas, the incidence of NPC increases with age and has a bimodal peak: the first in adolescents and young adults and the second after 65 years of age, whereas in endemic areas, the incidence increases after 30 years of age. EBV is considered in ‘Group 1’ by the International Agency for Research on Cancer (IARC) in respect to NPC. In regions where NPC is endemic, p16 positivity and human papillomavirus (HPV) expression (screened using RNA probes to detect 13 high-risk and 5 low-risk HPV types) is reported in up to 8% of non-keratinizing undifferentiated carcinoma. The treatment of localized NPC is based on radiotherapy and chemotherapy. For advanced and metastatic disease, the addition of immunotherapy to cisplatin and gemcitabine and maintenance seems to be beneficial as first-line treatment.

EBV infection is strongly associated with NPC. Plasma EBV DNA can be used to facilitate early diagnosis and recurrence monitoring and also has prognostic value, both before and just after the end of treatment. However, more research is needed to refine the role of plasma EBV DNA in the management of NPC and to identify additional molecular markers that could lead to advances in personalized medicine in NPC. Efficacy data and consequent recommendations described here are derived largely from studies in the endemic setting, where non-keratinizing, EBV-related carcinomas constitute most cases. Where the evidence is lower, these data will still be considered for non-endemic carcinomas. The optimal treatment strategy for patients with advanced NPC should be discussed within a multidisciplinary team (MDT). Treatment of patients in high-volume facilities is recommended as this was reported as an independent prognostic factor for improved survival, at least in areas where the disease is endemic.

Recently, two randomized phase III trials showed an increase in progression-free survival (PFS) when immunotherapy (camrelizumab or toripalimab) was added to first-line treatment with cisplatin and gemcitabine followed by maintenance immunotherapy (camrelizumab or toripalimab) for recurrent and/or metastatic disease. The addition of immunotherapy should therefore be considered, pending long-term results of overall survival benefit and the assessment of the role of maintenance therapy.

This Research Topic is accepting manuscripts on, but not limited to, the following themes:

-the implication of EBV and HPV expressions in the diagnosis, treatment, and prognosis

-the place of neoadjuvant and adjuvant chemotherapy

-the evaluation of radiotherapy dose and regimen

-the role of immunotherapy in the locally advanced, nonmetastatic nasopharyngeal cancer

-the place of immunotherapy in recurrent/metastatic nasopharyngeal cancer

Types of manuscripts accepted in this Research Topic: original research, meta-analyses, reviews.

Please note: manuscripts consisting solely of bioinformatics or computational analysis of public genomic or transcriptomic databases which are not accompanied by validation (independent cohort or biological validation in vitro or in vivo) are out of scope for this section and will not be accepted as part of this Research Topic.

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