Read about the latest research and clinical trials looking at nasopharyngeal cancer.
Research and clinical trials
All cancer treatments have to be fully researched before they can be used for everyone. This is so we can be sure that:
- they work
- they work better than the treatments already available
- they are known to be safe
Treatments are developed and tested in laboratories. For safety reasons, experimental treatments must be tested in the laboratory before they can be tried in patients. If a treatment described here is said to be at the laboratory stage of research, it is not ready for patients and is not available either within or outside the NHS. Cancer Research UK supports a lot of UK laboratory research into cancer.
Nasopharyngeal cancer research
Doctors continue to look for better ways of giving radiotherapy to treat nasopharyngeal cancers.
Intensity modulated radiotherapy (IMRT) is one newer technique. With IMRT the radiotherapy machine shapes both the beam and the dose to match the tumour shape and thickness. This is now a standard way of treating head and neck cancers.
You usually have radiotherapy once a day, Monday to Friday, for several weeks. Doctors are looking to see if it is better to give radiotherapy every day over a shorter period of time. They are also looking at giving more than 1 dose of radiotherapy a day.
In some UK hospitals doctors are using stereotactic radiotherapy for nasopharyngeal cancer that has come back. They want to see if it works better than standard radiotherapy. In stereotactic radiotherapy, beams are aimed at the tumour from many different directions in order to target the tumour very precisely.
In the US, researchers are looking into a different type of radiotherapy called proton beam radiotherapy. This aims to give a higher dose of radiation to the cancer and to only a very small area around it. This means there is less chance of damage to surrounding healthy tissue. Trials so far have not shown it to be better than IMRT.
Doctors are also looking at adaptive radiotherapy. This means changing the radiotherapy plan after treatment has started. This is because the tumour shrinks and changes shape during treatment, and you might lose weight. You have some of your initial scans again so that your radiotherapy team can create a new treatment plan.
The main treatment for cancer of the nasopharynx is radiotherapy. From research, doctors know that combining chemotherapy with radiotherapy (chemoradiotherapy) for people with stage 3 and 4 cancers, and some stage 2 cancers, works better than radiotherapy on its own.
Researchers are also looking into different types of chemotherapy that may work better and give fewer side effects. Research is also being done to find out the best chemotherapy to give patients before chemoradiotherapy. This is called induction chemotherapy.
The Epstein Barr virus (EBV) is thought to be linked to some nasopharyngeal cancers. Researchers are trying to find out how this virus helps cancers to develop.
Doctors are looking at how treatment to prevent EBV might be used to help treat cancers that contain the virus. Researchers hope a vaccine that gets the body’s immune system to recognise and attack EBV might kill cancer cells containing the virus.
A clinical trial tested a vaccine that boosts immunity against EBV. Results from this early phase trial showed that the vaccine was safe to use, with only mild side effects.
The trial team are now carrying out another early phase trial looking at a vaccine for nasopharyngeal cancer that contains EBV. They want to find out how the immune system responds to the vaccine, and to learn more about the side effects.
Scientists are looking at whether a test for EBV levels in the blood could help to monitor treatment in patients with advanced nasopharyngeal cancer.
Other scientists are trying to develop a vaccine to stop people catching EBV in the first place. This would have a big impact on cancer rates around the world.
Nasopharyngeal cancer is much more common in China than the UK. Researchers in China have been looking into screening people infected with EBV for nasopharyngeal cancer. People with antibodies for the EBV virus had check ups every year for 4 years. The screening found more nasopharyngeal cancers at an early stage.
Biological therapies act on processes in cancer cells or change the way that cells signal to each other. They can stimulate the body to attack or control the growth of cancer cells.
Monoclonal antibodies can block receptors on cancer cells that signal the cancer to grow.
Cetuximab (also known as Erbitux) is a monoclonal antibody that blocks a receptor called epidermal growth factor receptor (EGFR). It is an EGFR inhibitor.
Doctors can use cetuximab to treat some squamous cell head and neck cancers. But it is still being looked at in trials for nasopharyngeal cancer. Researchers are looking at combining it with chemotherapy to treat nasopharyngeal cancer that has spread to another part of the body, and with chemotherapy to treat locally advanced nasopharyngeal cancer.
They are also looking at using another EGFR inhibitor called nimotuzumab along with chemoradiotherapy to treat locally advanced nasopharyngeal cancer.
Bevacizumab (also called Avastin) is also being looked at for treating nasopharyngeal cancer. It targets a cancer cell protein called vascular endothelial growth factor. This protein helps cancers to grow blood vessels, so they can get food and oxygen from the blood. Blocking it stops the cancer from growing blood vessels, so it is starved and cannot grow.
Cancer growth blockers
There are different types of cancer growth blockers. One type are called tyrosine kinase inhibitors. Tyrosine kinase is a substance in cells that triggers them to grow and divide. Blocking (inhibiting) tyrosine kinase stops the cells growing and making more cells.
Researchers are testing various tyrosine kinase inhibitors, including:
- gefitinib (Iressa)
- sorafenib (Nexavar)
- erlotinib (Tarceva)
So far these drugs have not been shown to be very helpful when added to current treatments for nasopharyngeal cancer. But further research is needed.
PI3K inhibitors are another type of cancer growth blocker. In some cancers, PI3K is permanently switched on. This means that the cancer cells grow uncontrollably. Researchers are developing new treatments that block PI3K and stop cancer cells growing.
Buparlisib is a type of PI3K inhibitor. A trial is looking at buparlisib with paclitaxel chemotherapy for head and neck cancer that has come back or spread to another part of the body. It aims to see if paclitaxel and buparlisib together work better than paclitaxel and a dummy drug (placebo).
Possible new targets for biological therapy drugs
Other growth factor receptors that have been found in nasopharyngeal cancers include:
- c-KIT (CD117)
- c-erb-2 (HER2)
But we need clinical trials before we will know if targeting these receptors will lead to new treatments for this type of head and neck cancer.
Doctors are looking into using a virus called reovirus to help treat advanced head and neck cancers. Reovirus is made into Reolysin. Reovirus rarely causes any symptoms, but it can kill cancer cells.
A small trial looked at giving Reolysin at the same time as paclitaxel and carboplatin (PC chemotherapy) in people with advanced cancer. The researchers found that the cancer stayed the same or got smaller in more than half the people with head and neck cancer who had Reolysin and PC chemotherapy. The most serious side effects were a drop in the number of blood cells and low blood pressure.
The REO 18 trial is looking at giving Reolysin with paclitaxel and carboplatin chemotherapy for head and neck cancers that have spread to other parts of the body or have got worse despite having other treatment. The aim of the trial is to see if having Reolysin at the same time as carboplatin and paclitaxel helps these people more than having the chemotherapy alone. This trial has closed and we are waiting for the results.
Surgery is not a common treatment for nasopharyngeal cancer. The position of the nasopharynx in the head makes it very difficult to operate on.
Skull base surgery
A type of surgery called skull base surgery allows surgeons to reach these difficult areas. Skull base surgery has shown promise for some people with keratinising type nasopharyngeal cancers and for people whose cancer has come back.
Skull base surgery is very hard to do and needs a special team of surgeons. This technique is still experimental and only a few hospitals in the UK have specialists to carry it out.
Rarely, radiotherapy to the head and neck area can damage the jaw bone. This damage is called osteoradionecrosis (ORN). The problem develops because the blood supply to the area is reduced. Doctors think that a high pressure oxygen therapy called hyperbaric oxygen (HBO) may be able to stop this happening. The idea is that HBO works by increasing the supply of blood to the jaw.
The HOPON trial is looking at HBO for osteoradionecrosis. You may be able to join this trial if your cancer has been successfully treated with radiotherapy and you are going to have jaw or dental surgery. Doctors think that having dental surgery can trigger the problem.
If you do develop osteoradionecrosis after radiotherapy, your doctor may suggest surgery to remove the damaged jaw bone. HBO may help the bone to heal after surgery. Doctors want to test this in the DAHANCA 21 trial. Half the people taking part will have HBO before and after surgery to remove the bone. The other half will have surgery only.
One research study is looking at how well a new radioactive injection used in PET-CT scans can show up areas of head and neck cancer that are hard to treat. This study is checking whether the injection can show up areas of low oxygen levels in a cancer. If the injection shows up areas of low oxygen doctors may be able to then target higher doses of radiotherapy to those areas.
Doctors have also been trying a new way of scanning patients with head and neck cancer during treatment to see if they can get a better idea of how well the treatment is working. The scan is a combined PET-CT scan. PET-CT scans may give doctors more precise information than either PET scans or CT scans on their own.
Treatment for head and neck cancer can sometimes cause side effects that are difficult to cope with.
Helping to relieve a dry mouth
One of the main side effects of radiotherapy to the head and neck area is a dry mouth. Doctors call this xerostomia (pronounced zero-stow-mee-a). It happens because radiotherapy affects the glands that make saliva (spit) to keep your mouth moist. You may make less saliva than usual, or none at all.
A dry mouth is very uncomfortable and can make chewing, swallowing and even talking difficult. It can lead to serious weight loss problems. There is a need for new treatments because current treatments are limited. If you are making some saliva, a drug to stimulate your salivary glands may help. These include the drugs pilocarpine and bethanechol. But in about 15 in every 100 patients (15%) these drugs cause difficult side effects such as blurred vision, sickness, and sweating.
Recent research suggests that a drug called amifostine can reduce the number of people who have a dry mouth after chemotherapy and radiotherapy. This drug comes from a group of drugs called chemoprotectants, meaning that it helps to protect against side effects. A few minutes before each radiotherapy treatment, amifostine is injected into a vein in your arm. It aims to limit the amount of damage the radiation causes to the salivary glands. Side effects of amifostine include low blood pressure, dizziness, flushing, chills, and feeling or being sick. This drug is still experimental and not used as standard treatment. Amifostine is not licensed in the UK.
The LEONIDAS-2 study is looking at a medical device to stimulate the gums to increase the amount of saliva in the mouth. The researchers hope this will reduce the symptoms of dry mouth and improve quality of life.
Some studies suggest that having acupuncture can help with a dry mouth caused by radiotherapy in people with head and neck cancers. But we need more research before we know exactly how much it can help.
Acupuncture for pain after neck surgery
Some people who have a neck dissection operation to remove the lymph nodes in their neck also have their accessory nerve removed. The accessory nerve controls shoulder movement, and the surgery can leave your shoulder and neck stiff and painful. These side effects are usually treated with physiotherapy and non steroidal anti inflammatory pain killers (NSAIDs). Early research in the USA suggests that acupuncture may also help to relieve pain after a neck dissection.
Acupuncture and moxibustion to help relieve lymphoedema
Lymphoedema is swelling caused by a build up of lymph fluid in the body. It can be a side effect of surgery or radiotherapy treatment if the lymph nodes that usually drain the fluid are removed or damaged. Lymphoedema can cause discomfort, pain and difficulty moving. There is no cure for lymphoedema, but treatments can relieve symptoms.
A small trial looked at acupuncture and moxibustion for lymphoedema. These are types of complementary therapies. Acupuncture uses fine sterile needles which are put just under the skin at particular points (acupuncture points) on the body. In this trial, they did not put the acupuncture needles in the area affected by lymphoedema. Moxibustion uses a dried herb called mugwort which is rolled into a stick. The moxibustion practitioner holds the glowing end of the lit stick over acupuncture points to warm them.
The trial team found that acupuncture and moxibustion was safe. The people taking part reported some improvement in their symptoms. The team suggest that more research is needed to see how much it could help improve symptoms.