Treatments for stage 4 nasopharyngeal cancer

The following are treatment options for stage 4 nasopharyngeal cancer. Your healthcare team will suggest treatments based on your needs and work with you to develop a treatment plan.

Chemoradiation is a main treatment for stage 4A and 4B nasopharyngeal cancer. In chemoradiation, chemotherapy is given during the same time period as radiation therapy. Each treatment makes the other more effective.

Chemoradiation for stage 4 nasopharyngeal cancer uses cisplatin or another drug, such as fluorouracil (also called 5-fluorouracil or 5-FU) and external radiation therapy.

Chemotherapy is a standard treatment for stage 4C nasopharyngeal cancer.

Chemotherapy drug combinations that may be used to treat stage 4C nasopharyngeal cancer include:

• cisplatin with either fluorouracil, docetaxel, paclitaxel, gemcitabine or capecitabine
• carboplatin with either docetaxel or paclitaxel

If the cancer doesn’t respond to drugs used in earlier treatments, the following other drugs may be used:

• methotrexate
• epirubicin
• doxorubicin
• bleomycin

Chemotherapy with cisplatin and fluorouracil is often given after radiation or chemoradiation for stages 4A and 4B nasopharyngeal cancer.

You may be offered immunotherapy for stage 4C (metastatic) nasopharyngeal cancer.

Pembrolizumab (Keytruda) may be used as a first-line therapy to treat metastatic nasopharyngeal cancer. It may be given with or without chemotherapy.

Nivolumab (Opdivo) may be used to treat metastatic nasopharyngeal cancer that has stopped responding to chemotherapy with platinum drugs such as cisplatin or carboplatin.

You may be offered radiation therapy for stages 4A and 4B nasopharyngeal cancer if you can’t tolerate chemoradiation and its side effects. External radiation is given to the site of the tumour and to the lymph nodes in the neck (cervical lymph nodes).

For stage 4C nasopharyngeal cancer, radiation therapy may be given after chemotherapy. The radiation is directed at the primary tumour and the cervical lymph nodes.

A neck dissection is surgery to remove cervical lymph nodes. You may need a neck dissection after chemoradiation or radiation therapy for stage 4 nasopharyngeal cancer if there is still cancer in the cervical lymph nodes.

Other surgeries may be offered to relieve symptoms or give supportive care for advanced nasopharyngeal cancer. These include:

• placement of a feeding tube (usually with a gastrostomy) to make sure you get enough nutrients
• placement of a breathing tube (called a tracheostomy) to help you breathe

You may want to consider a type of care to make you feel better without treating the cancer itself. This may be because the cancer treatments don’t work anymore, they’re not likely to improve your condition or they may cause side effects that are hard to cope with. There may also be other reasons why you can’t have or don’t want cancer treatment.

Talk to your healthcare team. They can help you choose care and treatment for advanced cancer.

Talk to your doctor about clinical trials open to people with nasopharyngeal cancer. Clinical trials look at new ways to prevent, find and treat cancer. Find out more about clinical trials.