Synthetic educational example. Do not self-treat: a qualified treating physician must verify the sources, patient data, contraindications, and final plan.
Patient
VERIFIED-NPC-L1-NPC_1L_LOCALLY_ADVANCED_CCRT · Algorithm: ALGO-NPC-1L
Etiological driver
Etiological driver · etiologically_driven archetype
Nasopharyngeal carcinoma
- EBV (Epstein-Barr virus) — IARC Group 1 carcinogen; obligate etiology in non-keratinizing NPC of endemic regions
- Endemic geography — Southern China (Guangdong), Hong Kong, Taiwan, Southeast Asia, North Africa (Maghreb), Greenland Inuit
- Salted fish / preserved-food consumption (childhood exposure)
- Tobacco smoking (keratinizing-variant NPC)
- Familial clustering (HLA-A2 / HLA-B46 alleles in Chinese cohorts)
Clinical significance of mutations (ESCAT)
Tumor-board context — the engine does not use these tiers to rank tracks
| Biomarker | Variant | ESCAT | Evidence | Clinical significance | Drugs | Sources |
|---|
| No clinically actionable variants matched in this profile. |
Primary current-line option
- Indication
- IND-NPC-1L-LOCALLY-ADVANCED-CCRT
- Regimen
- Induction gemcitabine-cisplatin (GC) + concurrent cisplatin chemoradiation (IMRT) — locoregionally advanced nasopharyngeal carcinoma
- Drugs + NSZU
Induction — Induction gemcitabine+cisplatin (GC) chemotherapy before CCRT — cytoreduction and micrometastasis control; benefit demonstrated for locoregionally advanced (Stage III-IVA) NPC
- Gemcitabine (DRUG-GEMCITABINE) 1000 mg/m² IV · Days 1 and 8 of every 21-day cycle x 3 cycles · IV ⚠ NSZU — not for this indication
- Cisplatin (DRUG-CISPLATIN) 80 mg/m² IV · Day 1 of every 21-day cycle x 3 cycles · IV ⚠ NSZU — not for this indication
- Cisplatin (DRUG-CISPLATIN) 100 mg/m² IV · Day 1 and 22 (± day 43 depending on RT course length) every 3 weeks, concurrent with IMRT. Weekly cisplatin 40 mg/m² IV is an accepted lower-toxicity alternative schedule. · IV ⚠ NSZU — not for this indication
- Reason
- Primary current-line option selected by ALGO-NPC-1L at step 1.
Other current-line alternatives (1 tracks)
Same treatment line; review when biomarker, access, contraindication, or patient-context assumptions change.
- Indication
- IND-NPC-1L-METASTATIC-GC-PD1
- Regimen
- Toripalimab + gemcitabine + cisplatin (JUPITER-02) — 1L recurrent/metastatic nasopharyngeal carcinoma
- Drugs + NSZU
- Toripalimab (DRUG-TORIPALIMAB) 240 mg IV · Day 1 of every 21-day cycle, concurrent with GP cycles 1-6, then continued as monotherapy maintenance q3w until progression/unacceptable toxicity or up to 2 years total · IV ✗ Not registered in UA
- Gemcitabine (DRUG-GEMCITABINE) 1000 mg/m² IV · Days 1 and 8 of every 21-day cycle, cycles 1-6 only · IV ⚠ NSZU — not for this indication
- Cisplatin (DRUG-CISPLATIN) 80 mg/m² IV · Day 1 of every 21-day cycle, cycles 1-6 only · IV ⚠ NSZU — not for this indication
- Reason
- Current-line alternative presented for HCP consideration
Pre-treatment investigations
Investigations before treatment start · critical / standard / desired · merged across tracks
| ID | Name | Priority | Category | Where to order | Needed for |
|---|
| TEST-CBC | Complete Blood Count with Differential | Critical | lab | — | all tracks |
| TEST-CMP | Comprehensive Metabolic Panel | Critical | lab | — | all tracks |
| TEST-LFT | Liver Function Tests (ALT, AST, bilirubin, ALP, GGT, albumin) | Critical | lab | — | all tracks |
| TEST-AUDIOMETRY | Audiometry | Standard | clinical_assessment | — | all tracks |
| TEST-BRAIN-MRI-CONTRAST | Brain MRI with contrast | Standard | — | — | all tracks |
| TEST-CT-NECK-THORAX-ABDOMEN-PELVIS | CT neck/thorax/abdomen/pelvis | Standard | imaging | — | all tracks |
| TEST-EBV-VIRAL-LOAD | EBV DNA quantitative PCR | Standard | lab | — | all tracks |
| TEST-PET-CT | FDG PET/CT (whole body) | Standard | imaging | — | all tracks |
What NOT to do
Explicit prohibitive rules, each grounded in a regimen / supportive care / contraindication entity
Standard plan (IND-NPC-1L-LOCALLY-ADVANCED-CCRT)
- Do NOT use systemic PD-1 immunotherapy instead of definitive CCRT in non-metastatic (M0) disease — that is the metastatic-1L indication (IND-NPC-1L-METASTATIC-GC-PD1), not locally advanced disease.
- Do NOT omit baseline audiometry and renal function before cisplatin — cumulative oto-/nephrotoxicity risk increases when induction + concurrent phases are combined.
- Do NOT ignore post-treatment EBV-DNA surveillance — a rising level can precede radiographic relapse.
- Do NOT extend radiation beyond the standard definitive course without a documented clinical rationale.
Standard plan (IND-NPC-1L-METASTATIC-GC-PD1)
- Do NOT use toripalimab/camrelizumab monotherapy as 1L without a chemotherapy backbone outside of the platinum-ineligible palliative setting — both JUPITER-02 and CAPTAIN-1st studied PD-1 + GP combination, not monotherapy, in 1L.
- Do NOT exceed the cisplatin/gemcitabine cycle cap (6 cycles) — the GP chemo backbone stops at cycle 6 per trial protocol; the PD-1 agent continues as maintenance monotherapy.
- Do NOT omit baseline audiometry and renal function before the cisplatin-containing GP backbone.
- Do NOT continue anti-PD-1 therapy through grade 3-4 immune-related adverse events without corticosteroid management and specialist input.
Timeline
Treatment timeline — derived from regimen + monitoring schedule
Standard plan
Induction · Induction gemcitabine-cisplatin (GC) + concurrent cisplatin chemoradiation (IMRT) — locoregionally advanced nasopharyngeal carcinoma
21-day cycles × Induction (optional, Stage III-IVA): 3 cycles. Concurrent: 2-3 cisplatin doses q3w (or weekly x6-7) paired with the definitive IMRT course.
Standard plan
Induction · Toripalimab + gemcitabine + cisplatin (JUPITER-02) — 1L recurrent/metastatic nasopharyngeal carcinoma
21-day cycles × GP chemo backbone capped at 6 cycles per JUPITER-02 protocol; toripalimab continues as monotherapy maintenance until progression, unacceptable toxicity, or ~2 years total
MDT brief
Data quality
Usable with caveats. No critical default-track gap was found, but the MDT should review the listed caveats before final sign-off.
- Biomarker coverage: 0/0 known (100%), 0 missing, 0 default-track gaps
- Unevaluated RedFlags: RF-NPC-EBV-DNA-POST-TREATMENT-SURVEILLANCE
Technical MDT skill metadata (0/16 activated in this plan)
All registered virtual specialists. ✓ — activated for this case; ○ — not activated (available for other clinical scenarios).
| Specialist | skill_id | Version | Last reviewed | Sign-offs | Domain |
|---|
| Cellular therapy specialist (CAR-T) | cellular_therapy_specialist | v0.1.0 | 2026-04-25 | 0 | cellular_therapy |
| Clinical pharmacist | clinical_pharmacist | v0.1.0 | 2026-04-25 | 0 | clinical_pharmacy |
| Hematologist / oncohematologist | hematologist | v0.1.0 | 2026-04-25 | 0 | hematology_oncology |
| Hematopathologist (lymphoma / leukemia / myeloma) | hematopathologist | v0.1.0 | 2026-04-25 | 0 | hematopathology |
| Infectious disease / hepatology | infectious_disease_hepatology | v0.1.0 | 2026-04-25 | 0 | infectious_diseases |
| Medical oncologist (solid-tumor chemotherapist) | medical_oncologist | v0.1.0 | 2026-04-25 | 0 | solid_oncology |
| Molecular geneticist / molecular oncologist | molecular_geneticist | v0.1.0 | 2026-04-25 | 0 | molecular_oncology |
| Palliative care | palliative_care | v0.1.0 | 2026-04-25 | 0 | palliative_care |
| Pathologist (general) | pathologist | v0.1.0 | 2026-04-25 | 0 | pathology |
| Primary care / family physician | primary_care | v0.1.0 | 2026-04-25 | 0 | primary_care |
| Psycho-oncologist | psychologist | v0.1.0 | 2026-04-25 | 0 | psychosocial |
| Radiation oncologist | radiation_oncologist | v0.1.0 | 2026-04-25 | 0 | radiation_oncology |
| Radiologist | radiologist | v0.1.0 | 2026-04-25 | 0 | diagnostic_imaging |
| Social worker / case manager | social_worker_case_manager | v0.1.0 | 2026-04-25 | 0 | psychosocial |
| Surgical oncologist | surgical_oncologist | v0.1.0 | 2026-04-25 | 0 | surgical_oncology |
| Transplant specialist (BMT) | transplant_specialist | v0.1.0 | 2026-04-25 | 0 | cellular_therapy |
Sources cited
- SRC-CAPTAIN-1ST-YANG-2021: Camrelizumab versus placebo in combination with gemcitabine and cisplatin as first-line treatment for recurrent or metastatic nasopharyngeal carcinoma (CAPTAIN-1st): a multicentre, randomised, double-blind, phase 3 trial (2021)
- SRC-INTERGROUP-0099-ALSARRAF-1998: Superiority of chemoradiotherapy versus radiotherapy in patients with locally advanced nasopharyngeal cancer: preliminary results of Intergroup 0099 (1998)
- SRC-JUPITER-02-MAI-2021: Toripalimab plus chemotherapy for recurrent or metastatic nasopharyngeal carcinoma: the JUPITER-02 randomized clinical trial (2021)
- SRC-NCCN-HNSCC-2025: NCCN Clinical Practice Guidelines — Head and Neck Cancers (2025.v3)
- SRC-NPC-GC-INDUCTION-ZHANG-2019: Gemcitabine and Cisplatin Induction Chemotherapy in Nasopharyngeal Carcinoma (2019)
Experimental options (clinical trials)
Last synced: 2026-09-09 · ctgov.
No active trials matched this scenario in ctgov.
Option availability in Ukraine
Per-track UA registration · NSZU · cost · access pathway. Render-time metadata; engine selection does not depend on these fields (CHARTER §8.3).
| Option | UA registration | NSZU | Cost orientation | Access pathway |
|---|
| Standard plan Induction gemcitabine-cisplatin (GC) + concurrent cisplatin chemoradiation (IMRT) — locoregionally advanced nasopharyngeal carcinoma (REG-NPC-GC-INDUCTION-CCRT) | ✓ registered | ✓ covered | ₴-? — verify pathway | NSZU formulary |
| Standard plan Toripalimab + gemcitabine + cisplatin (JUPITER-02) — 1L recurrent/metastatic nasopharyngeal carcinoma (REG-NPC-GC-TORIPALIMAB) 1/3 component drug(s) not registered in Ukraine +1 | ✗ not registered | ✗ out-of-pocket | ₴-? — verify pathway | not recorded |
Cost information is orientation. Verify with a specific pharmacy / foundation / trial site. Status updated: 2026-09-09.