Research into nasopharyngeal cancer
Researchers around the world are looking at better ways to treat nasopharyngeal cancer and manage treatment side effects.
Go to Cancer Research UK’s clinical trials database if you are looking for a trial for nasopharyngeal cancer in the UK. You need to talk to your specialist if there are any trials that you think you might be able to take part in.
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.
The video below shows what it is like to take part in a trial.
Ash: I was offered a place on a trial by my cancer nurse
Jean: There was a new trial with new drugs and they were confident it would work and they offered it to me and I’m so glad I took it.
Nilesh: What we did, my wife and I, was to do some research on the internet. We came across the source trial which is what I went on and we took that to the doctor and then requested that we be put on to that.
Amy: The only thing that did sort of trouble us as a family when they did tell us was that it was possibly quite painful and there may be some side effects that they didn’t know about.
Ash: I was quite concerned about taking part in a trial because you hear the word trial and you think its test.
Nilesh: You know you hear about trials, clinical trials, drug trials things like that. My reservations were what the side effects were going to be.
Ash: I decided it was the right thing for me because it would potentially offer patients in the future less side effect risk.
Jean: There were lots of questions I had to ask and they were all answered and I was confident in going through the trial and the after care.
Nilesh: Right from day one they’ve been monitoring me. You know I have regular checkups and all that.
Amy: Any symptoms that arose with Poppy, somebody was always there to make sure that she wasn’t in any pain or any suffering.
Ash: I didn’t feel that they were hiding anything from me which when you’re talking about a clinical trial is so important.
Jean: It’s a really warm feeling knowing that what you did has helped other people.
Nilesh: I just hope that I played a part in a new drug that’s out there.
Ash: For other patients and also for society in general.
Nilesh: You’ve got to feel comfortable about the trial itself before you sign up for it. So do your background knowledge and just be 100% that that’s where you want to go.
Ash: Think about it very carefully. Read all of the background literature and ask lots and lots of questions because there’s no harm in doing that.
Nasopharyngeal cancer is rare in the UK. Much of the research is taking place in countries where this type of cancer is a lot more common. So not all the research mentioned below is taking place in the UK.
Treatment
Radiotherapy
Doctors and researchers continually try to further develop radiotherapy techniques to make sure the cancer gets the highest dose, and surrounding healthy tissue only receives a small amount. This helps to reduce side effects.
Researchers are looking at adjusting radiotherapy planning during a course of chemoradiotherapy. You always have a planning appointment before you start radiotherapy. But researchers are looking at doing another plan after the first few treatments, using specialised MRI scans as well as the usual CT scans. This is because the cancer can change size and shape during treatment. They hope that by doing this they can better target the cancer with the radiotherapy and reduce the amount of radiation to nearby tissues. It is called adaptive radiotherapy.
Other types of radiotherapy are being looked at for nasopharyngeal cancer, particularly in China, including proton beam therapy and carbon ion therapy. Researchers hope these techniques will reduce side effects, but larger studies are needed.
Immunotherapy
Immunotherapy works by helping the immune system recognise and attack cancer cells. It is an interesting area of research for many different types of cancer.
There are different types of immunotherapy being looked at in head and neck cancer.
Immunotherapy cancer drugs
Early trials with immunotherapy drugs have shown promising results with nasopharyngeal cancer that has come back (recurrent cancer) or has spread to other parts of the body (metastatic cancer). Researchers around the world are looking at different immunotherapy drugs, mainly checkpoint inhibitors. These drugs include:
- nivolumab
- pembrolizumab
- camrelizumab
- sintilimab
- toripalimab
- tislelizumab
Researchers want to find out how helpful it is to have these types of drugs and when the best time would be to have them for nasopharyngeal cancer. They are looking to see if it is helpful to have immunotherapy:
- with chemotherapy or chemoradiotherapy
- as part of induction treatment before chemoradiotherapy
- after chemoradiotherapy
- with another immunotherapy drug, either at the same time or one after the other
Vaccines
Scientists have been developing a vaccine containing the Epstein Barr virus (EBV). EBV is linked to some nasopharyngeal cancers. Researchers hope a vaccine that gets the body’s immune system to recognise and attack EBV might kill cancer cells containing the virus. Results from an early phase trial showed that the vaccine was safe to use, with only mild side effects.
T4 immunotherapy
T4 immunotherapy is a new cancer treatment. It works by helping a type of white blood cell called T cells attack the cancer. Early research is testing the safest dose of T4 immunotherapy in people with head and neck cancers. Doctors inject the T4 immunotherapy directly into the cancer. The people taking part also have chemotherapy through a drip into the bloodstream. Doctors want to find out if the treatment shrinks or controls the cancer.
Tests during and after treatment
Doctors are keen to find a more accurate way of seeing whether there are any cancer cells left after treatment. They hope that using a type of MRI scan called diffusion weighted MRI (DW-MRI) might be useful. DW-MRI scans measure the water movement between cells.
Researchers want to find out whether DW-MRI scans are helpful for seeing how well treatment for head and neck cancer has worked. Doctors hope the scans will help them decide who needs more treatment.
There is emerging evidence that testing for levels of the Epstein Barr virus (EBV) in the blood may help doctors work out how well treatment is working for nasopharyngeal cancer. They may also be able to use the test to help pick up if the cancer comes back after treatment.
Side effects of treatment
In trials looking at treatments for cancer, researchers always look at the side effects of treatment both in the short term and long term, and how they affect quality of life. Researchers also do trials to look at specific side effects to see if there are better ways to manage them.
Treatment for nasopharyngeal cancer can cause side effects that can be difficult to live with, and some may be long term. Newer radiotherapy techniques for head and neck cancers are helping to reduce some of these side effects.
Researchers are looking at different ways of managing certain side effects of treatment for head and neck cancers, including nasopharyngeal cancer, such as;
- looking at ways of preventing or treating damage to the jaw bone, which is a rare side effect of radiotherapy
- reducing the risk of a dry mouth following radiotherapy (xerostomia)
- possible new ways to reduce getting a sore mouth and ulcers (mucositis) after radiotherapy
