Individualized Treatment Treating Patients With Stage II-IVB Nasopharyngeal Cancer Based on EBV DNA

To join this study, you must have nasopharyngeal cancer that has been confirmed by a biopsy. This cancer should be at stages II, III, IVA, or IVB, meaning it's not yet spread to distant parts of your body. You also need to be at least 18 years old.

Before you can officially join, several tests are required. These include a physical exam, an assessment by a specialist doctor like an oncologist, and imaging scans such as an MRI or CT scan of your head and neck to understand the cancer's exact location. You will also need chest and abdominal scans to ensure the cancer hasn't spread elsewhere.

Crucially, your blood will be tested for the Epstein-Barr virus (EBV) DNA. For a specific part of the study, you must have detectable EBV DNA found in your blood before you start treatment.

If you join this study, you will first undergo standard treatment, which includes radiation therapy five days a week for about six and a half weeks, along with a chemotherapy drug called cisplatin given once a week. After this initial chemotherapy and radiation, a blood sample will be taken to check for EBV DNA.

What happens next depends on your EBV DNA test results. If no EBV DNA is found, you will be randomly assigned to either receive more standard chemotherapy (cisplatin and fluorouracil) or to be closely observed without further chemotherapy. If EBV DNA is still detected, you will be randomly assigned to receive either standard chemotherapy (cisplatin and fluorouracil) or a different chemotherapy combination (gemcitabine and paclitaxel).

Throughout the study, you will have regular visits for check-ups, blood tests, and imaging scans to monitor your health and the cancer. There will also be assessments to understand your quality of life. The total duration of participation will depend on which treatment group you are in and how you respond to treatment, and will include follow-up appointments after your main treatment ends.