Nasopharyngeal cancer research

All potential new treatments have to be fully researched before they can be used as standard treatment for everyone. This is so that

• We can be sure they work
• We can be sure they work better than the treatments that are 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.

Tests of treatments on patients are called clinical trials. There is information about clinical trials, including the 4 phases of clinical trials in the trials and research section. In that section you can also visit our searchable database of clinical trials. Choose 'nasopharyngeal cancer' from the dropdown menu box and click 'search'. If there is a trial you are interested in, print it off and take it to your own specialist. If the trial is suitable for you, your doctor will need to refer you to the research team. The database also has information about closed trials and trial results.

Everything covered on this page is the subject of ongoing research. Until studies are completed and new effective treatments are found, these experimental treatments cannot be used as standard therapy for nasopharyngeal cancers.

Doctors are looking at finding better ways of giving radiotherapy to treat cancers of the nasopharynx. One of these is intensity modulated radiotherapy (IMRT). In IMRT the radiotherapy machine shapes both the beam and the dose to match the tumour shape and thickness.

Because the radiotherapy beam is shaped to match the tumour IMRT gives less radiotherapy to normal tissues compared to standard radiotherapy. Research shows that long term side effects such as dry mouth are milder or less common with IMRT. This is a new treatment but should now be available in every cancer network in England.

In some UK hospitals doctors are also using stereotactic radiotherapy for nasopharyngeal cancer that has come back. They want to see if it works better than standard radiotherapy.

The main treatment for cancer of the nasopharynx is radiotherapy. Researchers have found that combining chemotherapy with radiotherapy for people with stage 2 and stage 3 and stage 4 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 as a first treatment (induction chemotherapy).

Viruses can help to cause some cancers. 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. A clinical trial recently 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 researchers suggest that it is now looked at in larger trials. 

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. 

EBV is a very common viral infection and nasopharyngeal cancer is rare in the UK. There is no screening programme in the UK for nasopharyngeal cancers. It would be very expensive to screen everyone for a disease that affects a small number of people.

Scientists are also looking at whether a test for EBV levels in the blood could help to monitor treatment in patients with advanced nasopharyngeal cancer.

Biological therapies are treatments that act on processes in cancer cells. They can work in different ways such as changing the way cells signal to each other or by stimulating the body to attack or control the growth of cancer cells. Research into biological therapies for nasopharyngeal cancer includes

• Monoclonal antibodies
• Tyrosine kinase inhibitors
• Possible new targets for biological therapy drugs
• Gene therapy

Monoclonal antibodies

Monoclonal antibodies (MABs) 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). Cetuximab has been tested in trials for locally advanced cancer of the nasopharynx. The trials found that people treated with cetuximab and radiotherapy lived longer than people who only had radiotherapy. Cetuximab is now licensed in combination with radiotherapy to treat squamous cell head and neck cancers that have spread into nearby tissues. There is information about this on the page about biological therapy for nasopharyngeal cancer. 

There is ongoing research looking at chemotherapy with cetuximab for nasopharyngeal cancers.

Research is looking into a number of different monoclonal antibodies, including zalutumumab. Zalutumumab blocks epidermal growth factor receptors (EGFR) on cancer cells. A phase 3 trial looked at zalutumumab for people with head and neck cancer that had come back after chemotherapy. It compared zalutumumab and best supportive care with supportive care on its own. Best supportive care means you have treatment to control symptoms. The trial showed that the cancer stopped growing for slightly longer in people who had zalutumumab. 

Tyrosine kinase inhibitors

Tyrosine kinase is a substance within cells that triggers them to grow and divide. Blocking (inhibiting) tyrosine kinase stops the cells growing and making more cells. There are a number of different tyrosine kinase inhibitor drugs. 

Researchers are testing a tyrosine kinase inhibitor called Iressa (also called ZD 1839 or gefitinib). Iressa is not yet licensed in the UK for head and neck cancer. But trials are using Iressa for many types of cancer, including head and neck cancers that have come back after treatment. Research so far has not shown Iressa to work any better than chemotherapy.

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)
• Vascular endothelial growth factor (VEGF)

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.

Gene therapy

Researchers have used a new type of biological therapy called OncoVEX GM-CSF alongside standard treatment for head and neck cancer that had spread to the lymph nodes. In a small trial, 17 people had treatment with radiotherapy and cisplatin chemotherapy as well as OncoVEX GM-CSF which is placed directly into the cancer. OncoVEX is a cancer killing virus. It also triggers the immune system to find and kill cancer cells elsewhere. So far researchers have found that the OncoVEX can shrink tumours or help to stop the cancer coming back in some people. This is a small study but the cancer responded to the treatment in 14 people. So the researchers plan bigger trials using this treatment.

These trials are still in very early stages. We need larger trials before we will know whether these treatments are any better at treating head and neck cancers than the treatments used now.

Doctors are looking into using a virus called reovirus to help treat advanced head and neck cancer. 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.

Another trial is looking at using Reolysin with radiotherapy. It wants to find out whether these treatments will work better together than they would separately. And to learn more about the side effects. The virus is injected straight into the tumour.

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.

You can find more information about these trials on the clinical trials database.

Surgery is not a common treatment for nasopharyngeal cancer. The position of the nasopharynx in the head makes it very difficult to operate on. 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.

Radiotherapy to the head and neck area can damage the jawbone. But this is rare. This damage is called osteoradionecrosis (ORN). The problem develops because the blood supply to the jawbone is reduced. The HOPON trial is looking at whether high pressure oxygen therapy called hyperbaric oxygen (HBO) may help to stop this happening. The aim is that HBO works by increasing the blood supply to the jaw. 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 surgery after radiotherapy can trigger osteoradionecrosis.

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. There is information below about research into

• Helping to relieve a dry mouth
• Acupuncture for pain after neck surgery
• Acupuncture and moxibustion to help relieve lymphoedema

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.

Our section about mouth problems with cancer has detailed information about treatments for a dry mouth.

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

If the lymph nodes are removed or damaged, lymphoedema can occur as a side effect of surgery or radiotherapy treatment. Lymphoedema is swelling caused by a build up of lymph fluid in the body. It can cause discomfort, pain, and difficulty moving. There is no cure for lymphoedema, but treatments can relieve symptoms. 

There is a small trial looking at whether the complementary therapies acupuncture and moxibustion can help to relieve the symptoms of lymphoedema. Acupuncture uses fine sterile needles which are put just under the skin at particular points (acupuncture points) on the body. You can find information about the acupuncture and moxibustion trial on the clinical trials database.