A comprehensive review and characterization of nasopharyngeal carcinoma clinical trials

ObjectiveAlthough standard of care for primary nasopharyngeal carcinoma (NPC) is chemoradiotherapy, there remains no consensus on management of recurrent or metastatic disease. We characterized recent clinical trials on NPC to assess trends in NPC treatment and establish promising areas for future research.Study DesignRetrospective database study.Setting database.MethodsRetrospective review of all NPC trials from November 1999 to June 2021. For each study, the following variables were extracted: study characteristics, intervention, outcome measures, and inclusion criteria. Secondary searches via PubMed and Google scholar determined trial publication status.ResultsA total of 448 clinical trials were identified: 72 (16%) observational and 376 (84%) interventional, of which there were 30 (8%) Phase I, 183 (49%) Phase II, 86 Phase III (23%), and 5 (1%) Phase IV trials. Fifty-four percent of trials included only primary NPC while 111 (25%) exclusively studied recurrent cancers. The most common interventions were cisplatin (n = 64) and intensity modulated radiation therapy (n = 54); there were 38 trials involving PD-1 monoclonal antibodies. Thirty-four studies examined quality of life measures, including xerostomia and mucositis. Of the completed studies, 53.2% have published manuscripts. Poor patient accrual was the most common reason for premature study termination.ConclusionsNovel immunotherapies have been increasingly incorporated into NPC studies in recent years, however, chemotherapy and radiation, despite their numerous side effects, are still widely used due to their clinical effectiveness. Future trials are warranted to determine the optimal therapeutic regimens to decrease relapse rates and side effects. Nasopharyngeal carcinoma clinical trials. Key points image Significant findings of the study: Through a comprehensive review of the database, we found that only 25% of registered nasopharyngeal carcinoma (NPC) trials have been completed. Current trials focus on the addition of immunotherapy to traditional radiation and chemotherapy regimens. What this study adds: Despite advances in cancer therapy, there are limited completed and published Phase 3 trials in NPC, warranting future studies to examine optimal combination therapies to increase recurrence-free and overall survival.