Curative-intent management of de novo metastatic nasopharyngeal carcinoma: an evidence-based consensus guideline from the International Collaborating Oncology Organisations

Patients with de novo metastatic nasopharyngeal carcinoma were historically deemed incurable and treated with palliative intent. Emergence of potent systemic therapy in combination with local treatment for both locoregional and metastatic diseases has enabled long-term survival in some patients. This international guideline was developed through consensus-building by 54 experts from 46 centres across 18 countries or regions and endorsed by 17 oncology organisations. 32 recommendations across seven clinical domains were formulated, including 29 strong (≥80% agreement [consensus] or high quality of evidence) and three conditional recommendations (67-79% agreement). We recommend that curative-intent treatment should be offered to medically fit patients with no more than three metastatic lesions in two or fewer organs at baseline or following response to systemic therapy; multimodality treatment (comprising immunochemotherapy, locoregional radiotherapy, metastasis-directed therapy, and maintenance therapy) is recommended. This guideline provides a practical framework for standardisation of clinical management of de novo metastatic nasopharyngeal carcinoma and identification of key evidence gaps for future research.