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Challenges of Current Management in Nasopharyngeal Carcinoma from a Perspective of a High Incidence Developing Country

Abstract Nasopharyngeal carcinoma (NPC) is endemic in many of East Asian countries. Epstein-Barr virus (EBV) infection, environmental factors and genetic predisposition are known risk factors for endemic form of NPC. We reported a retrospective epidemiological data of our newly diagnosed histologically confirmed NPC cases over 7 years. Total 1102 cases were identified. Ethnic Bidayuh has one of the highest crude rate in the world at 25.42 per 100,000 population. Eight and a quarter percent of the entire cohort had family history. There were 33 children and adolescent cases reported. Such high incidence was compounded by late presentation (85.1% were stage III to IV disease). Despite robust data on plasma EBV DNA in screening of at-risk populations, accessibility of such tests remains an issue in developing countries. Moreover, there are still limited approved treatment options available in addition to conventional multimodalities strategy with radiation and chemotherapy. Lack of strong data on targeted and immunotherapeutic options poses challenge in the management of this dismal tumor despite various ongoing studies. NPC is a huge health burden to high incidence areas especially in developing world. Better understanding of this intriguing tumor is essential in improving value-based treatment for developing countries.