Novel systemic therapeutic for nasopharyngeal carcinoma.

INTRODUCTION: Systemic therapy is crucial to the management of locally advanced or metastatic nasopharyngeal cancer (NPC). Despite initial responses, the benefits of conventional chemotherapy are seldom durable and the toxicities are intolerable to most patients. Therefore, novel therapies based on molecular targets of NPC have become the focus of development. AREAS COVERED: Three novel therapeutics, targeting EGFR, angiogenic processes and epigenetic dysregulation, are discussed in this review. The scientific basis and latest published results of clinical trials are also highlighted. EXPERT OPINION: In summary, cetuximab, an anti-EGFR monoclonal antibody shows promising results in both locally advanced and metastatic disease. Anti-angiogenic therapy such as sunitinib is efficacious but hemorrhagic complications are of concern in selected patients. Finally, translational studies demonstrate that epigenetic therapeutics could restore the immunogenicity of Epstein-Barr virus in NPC cells. For anti-EGFR therapy, the promising results in early clinical trials should be validated in Phase III clinical trials. Better selection of patients and safer therapy is necessary in future development of anti-angiogenic therapy for NPC. Early clinical trials on epigenetic therapeutics are in process and results are eagerly awaited.