| Stratification | Grade I recommendations | Grade II recommendations | Grade III recommendations |
|---|---|---|---|
| First‐line treatment |
Cisplatin + gemcitabine + camrelizumab [146] (evidence 1A) Cisplatin + gemcitabine + toripalimab [147] (evidence 1A) Cisplatin + gemcitabine [148] (evidence 1A) Systemic chemotherapy + local radiotherapy † [149] (evidence 1A) |
Cisplatin / carboplatin + 5‐fluorouracil [150, 151] (evidence 1A) Cisplatin + docetaxel [152] (evidence 2A) Carboplatin + paclitaxel [153] (evidence 2A) Cisplatin + capecitabine [154] (evidence 2A) Cisplatin + albumin‐bound paclitaxel [155] (evidence 2A) |
Cisplatin + gemcitabine + Endostar [156] (evidence 2B) |
| Second‐ or further‐line treatment |
Monotherapy chemotherapy Capecitabine [157, 158] (evidence 2A) or docetaxel [159] (evidence 2A) or gemcitabine [160] (evidence 2A) (If the same drugs are not accepted in the first‐line treatment) Encourage patients to participate in clinical trials |
Gemcitabine + vinorelbine [161, 162] (evidence 2A) Irinotecan [163] (evidence 2A) (If the same drugs are not accepted in the first‐line treatment) |
Camrelizumab [164] (evidence 2B) Toripalimab [165] (evidence 2B) Nivolumab [166] (evidence 2B) Pembrolizumab [167] (evidence 2B) (Limited to PD‐L1 TPS ≥ 1%) (If PD‐1 / PD‐L1 inhibitors are not accepted in the first‐line treatment) |
| Third‐ or further‐line treatment |
Toripalimab [165] (evidence 2A) Camrelizumab [164, 168] (evidence 2A) (If PD‐1 / PD‐L1 inhibitors were not received in the past) Capecitabine [157, 158] (evidence 2A) or docetaxel [159] (evidence 2A) or gemcitabine [160] (evidence 2A) (If the same drugs were not received in the past) Encourage patients to participate in clinical trials |
Gemcitabine + vinorelbine [161, 162] (evidence 2A) Irinotecan [163] (evidence 2A) (If the same drugs are not accepted in the past) |
Nivolumab [166] (evidence 2B) Pembrolizumab [167] (evidence 2B) (Limited to PD‐L1 TPS ≥ 1%) (If PD‐1 / PD‐L1 inhibitors are not accepted in the first‐line treatment) |
Abbreviations: PD‐1, programmed cell death 1; PD‐L1, programmed cell death l ligand 1; TPS, treatment planning system.
*This recommendation is based on published papers only. Recurrent NPC, which can be treated by surgery or local radiotherapy should be referred to the part of the treatment of recurrent NPC.
†These treatments are limited to patients with newly diagnosed metastatic NPC who achieved partial or complete remission after 3 cycles of chemotherapy.