A multicenter retrospective analysis of recurrent/metastatic nasopharyngeal cancer from non-endemic areas: Results in the pre-immunotherapy era

Aim of the study: The aim of the study is to describe clinical features, treatment approach and outcomes of recurrent/metastatic (R/M) NPC in non-endemic areas Materials and methods: This observational, retrospective and multicenter study was conducted within 36 referral hospital in non-endemic areas including Europe, Jordan, Kuwait, Turkey and United States of America. All NPC patients diagnosed between 2004 and 2016 and with a minimum 12 months of follow-up were included. Data entry started in January 2018 and closed in December 2023. Results: A total of 454 patients with R/M NPC were included in this analysis. The most frequent histology was non-keratinizing carcinoma (87 %); de novo metastatic patients had an EBV-related disease in 93 % of the cases. Among those with relapsed disease, locoregional recurrence was the most frequent site of recurrence, while bone was the principal site of metastatic dissemination (58 % of cases). Regarding treatment strategies, patients with loco-regional relapse received re-irradiation more frequently than salvage surgery (43 % vs 38 %). Overall, most of the patients with R/M disease received at least one line of systemic therapy. Median PFS was 13 months, while the median OS was 30 months (range 1-180) with a three year-OS rate of 47 %. Conclusions: This study reports the largest available clinical data defining the outcome of non-endemic patients with R/M NPC. In the context of rare cancers, these data represent the benchmark to define new therapeutic strategies and confirms a similar behaviour of NPC between endemic and non-endemic NPC when correlated with EBV status