Emerging treatments

Camrelizumab

Camrelizumab, a PD-1 blocking monoclonal antibody, has shown improved progression-free survival when used in combination with cisplatin plus gemcitabine compared with placebo in one randomized phase 3 trial comprising patients with previously untreated recurrent or metastatic nasopharyngeal carcinoma.[37][38]​​​ Another open-label, randomized phase 3 study demonstrated event-free survival benefit (3-year event-free survival 86.9% vs. 77.4%) of adjuvant camrelizumab, when the patients were randomized to camrelizumab or observation after completion of induction chemotherapy and definitive chemoradiation.[39]​ The European Society of Medical Oncology (ESMO) recommends that camrelizumab may be added to cisplatin plus gemcitabine.[40]​ However, it is not approved in Europe as yet. Camrelizumab is not approved in the US or recommended by the US guidelines.

Sintilimab

Sintilimab, an investigational PD-1 blocking monoclonal antibody, demonstrated event-free survival benefit (3-year event-free survival 86% vs. 76%) in an open-label, randomized phase 3 trial in patients with nonmetastatic stage 3-4A locoregionally advanced nasopharyngeal carcinoma (excluding T3-4, N0 and T3, N1). In this study, sintilimab was integrated with induction chemotherapy and continued through definitive chemoradiation and adjuvant phase after radiation.[41]

Capecitabine

For advanced stage disease, adjuvant capecitabine (an antimetabolite chemotherapy) with either metronomic or standard dosing has shown to improve failure-free survival and overall survival in randomized phase 3 trials.[1][40]​​​[42]​​​

Nanatinostat plus valganciclovir

Interim results of the phase 1B/2 trial evaluating the combination of the histone deacetylase inhibitor (HDAC) nanatinostat plus the antiviral agent valganciclovir for the treatment of Epstein-Barr virus (EBV)-positive nasopharyngeal carcinoma are promising.[43]​ The FDA has granted an orphan drug designation to this combination in patients with recurrent or metastatic EBV-positive nasopharyngeal carcinoma.

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