OpenOnco · Treatment Plan

Treatment plan — Nasopharyngeal carcinoma

PLAN-VERIFIED-NPC-L1-NPC_1L_METASTATIC_GC_PD1-V1 · v1 · 2026-07-15

Patient

VERIFIED-NPC-L1-NPC_1L_METASTATIC_GC_PD1 · Algorithm: ALGO-NPC-1L

DiagnosisNasopharyngeal carcinoma

MOH / ICD-10C11

ICD-O-38071/3; C11

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

Standard plan

★ DEFAULT

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

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.

Standard plan

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

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-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.

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.

Timeline

Treatment timeline — derived from regimen + monitoring schedule

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

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.

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	Domain
Cellular therapy specialist (CAR-T)	`cellular_therapy_specialist`	v0.1.0	2026-04-25	cellular_therapy
Clinical pharmacist	`clinical_pharmacist`	v0.1.0	2026-04-25	clinical_pharmacy
Hematologist / oncohematologist	`hematologist`	v0.1.0	2026-04-25	hematology_oncology
Hematopathologist (lymphoma / leukemia / myeloma)	`hematopathologist`	v0.1.0	2026-04-25	hematopathology
Infectious disease / hepatology	`infectious_disease_hepatology`	v0.1.0	2026-04-25	infectious_diseases
Medical oncologist (solid-tumor chemotherapist)	`medical_oncologist`	v0.1.0	2026-04-25	solid_oncology
Molecular geneticist / molecular oncologist	`molecular_geneticist`	v0.1.0	2026-04-25	molecular_oncology
Palliative care	`palliative_care`	v0.1.0	2026-04-25	palliative_care
Pathologist (general)	`pathologist`	v0.1.0	2026-04-25	pathology
Primary care / family physician	`primary_care`	v0.1.0	2026-04-25	primary_care
Psycho-oncologist	`psychologist`	v0.1.0	2026-04-25	psychosocial
Radiation oncologist	`radiation_oncologist`	v0.1.0	2026-04-25	radiation_oncology
Radiologist	`radiologist`	v0.1.0	2026-04-25	diagnostic_imaging
Social worker / case manager	`social_worker_case_manager`	v0.1.0	2026-04-25	psychosocial
Surgical oncologist	`surgical_oncologist`	v0.1.0	2026-04-25	surgical_oncology
Transplant specialist (BMT)	`transplant_specialist`	v0.1.0	2026-04-25	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)

Third plan track — open-enrollment trials from ClinicalTrials.gov. Render-time metadata; engine selection is not affected by this block (CHARTER §8.3). Last synced: 2026-07-15.

NCT	Title	Phase	Status	Sponsor	UA	Signals
NCT06472713	Clinical Study of Mitoxantrone Hydrochloride Liposome Combined with PD-1 Blockade in Recurrent or Metastatic NPC	PHASE2	RECRUITING	Ming-Yuan Chen	—	Small N (<50) Surrogate endpoint only Single country
NCT07362979	Toripalimab Combined With Different Platinum-Based Induction Chemotherapy Regimens for Locally Advanced Nasopharyngeal Carcinoma	PHASE2	RECRUITING	Sun Yat-sen University	—	Surrogate endpoint only Single country
NCT04340024	Discovery of Biomarkers for Intrinsic Radiation Sensitivity in Cancer Patients	N/A	RECRUITING	National Cancer Centre, Singapore	—	Single country
NCT06455410	GP Plus Adebrelimab Versus GP Neoadjuvant Chemotherapy for Nasopharyngeal Carcinoma	PHASE2	RECRUITING	Sun Yat-sen University	—	Single country
NCT07392320	A Phase II Trial Comparing Immunotherapy Versus Capecitabine Maintenance After Chemo-chemoradiotherapy for High-risk Nasopharyngeal Carcinoma	PHASE2	RECRUITING	Sun Yat-sen University	—	Surrogate endpoint only Single country
NCT06349889	Adebrelimab and Chemoradiotherapy in High-risk LANPC	PHASE2	RECRUITING	Sun Yat-sen University	—	Single country
NCT06662058	Remote Audiometry to Monitor for Treatment-Related Hearing Loss in Patients With H&N SCC Receiving Cisplatin and/or Radiation	NA	RECRUITING	Emory University	—	Single country
NCT06851247	GAPP Induction and Concurrent Chemoradiotherapy Followed by Toripalimab Maintenance for Nasopharyngeal Carcinoma.	PHASE2	RECRUITING	Sun Yat-sen University	—	Small N (<50) Surrogate endpoint only Single country
NCT05854849	Gemcitabine and Camrelizumab Plus Apatinib Versus Cisplatin in First-line Treatment of RM-NPC	PHASE3	RECRUITING	Sun Yat-sen University	—	Surrogate endpoint only Single country
NCT05340491	Chemoradiotherapy Plus Anti-PD1 in Recurrent NPC: A Multicenter, Open-label, Randomised, Controlled, Phase III Trial	PHASE3	RECRUITING	Sun Yat-sen University	—	Single country

Verify recruitment status directly with the trial site. ctgov data can lag behind current UA-site status.

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 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
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
Trial · NCT06472713 Clinical Study of Mitoxantrone Hydrochloride Liposome Combined with PD-1 Blockade in Recurrent or Metastatic NPC No UA site listed — international referral required	— unknown	— unknown	self-pay: ₴0/course	Trial sponsor
Trial · NCT07362979 Toripalimab Combined With Different Platinum-Based Induction Chemotherapy Regimens for Locally Advanced Nasopharyngeal Carcinoma No UA site listed — international referral required	— unknown	— unknown	self-pay: ₴0/course	Trial sponsor
Trial · NCT04340024 Discovery of Biomarkers for Intrinsic Radiation Sensitivity in Cancer Patients No UA site listed — international referral required	— unknown	— unknown	self-pay: ₴0/course	Trial sponsor
Trial · NCT06455410 GP Plus Adebrelimab Versus GP Neoadjuvant Chemotherapy for Nasopharyngeal Carcinoma No UA site listed — international referral required	— unknown	— unknown	self-pay: ₴0/course	Trial sponsor
Trial · NCT07392320 A Phase II Trial Comparing Immunotherapy Versus Capecitabine Maintenance After Chemo-chemoradiotherapy for High-risk Nasopharyngeal Carcinoma No UA site listed — international referral required	— unknown	— unknown	self-pay: ₴0/course	Trial sponsor
Trial · NCT06349889 Adebrelimab and Chemoradiotherapy in High-risk LANPC No UA site listed — international referral required	— unknown	— unknown	self-pay: ₴0/course	Trial sponsor
Trial · NCT06662058 Remote Audiometry to Monitor for Treatment-Related Hearing Loss in Patients With H&N SCC Receiving Cisplatin and/or Radiation No UA site listed — international referral required	— unknown	— unknown	self-pay: ₴0/course	Trial sponsor
Trial · NCT06851247 GAPP Induction and Concurrent Chemoradiotherapy Followed by Toripalimab Maintenance for Nasopharyngeal Carcinoma. No UA site listed — international referral required	— unknown	— unknown	self-pay: ₴0/course	Trial sponsor
Trial · NCT05854849 Gemcitabine and Camrelizumab Plus Apatinib Versus Cisplatin in First-line Treatment of RM-NPC No UA site listed — international referral required	— unknown	— unknown	self-pay: ₴0/course	Trial sponsor
Trial · NCT05340491 Chemoradiotherapy Plus Anti-PD1 in Recurrent NPC: A Multicenter, Open-label, Randomised, Controlled, Phase III Trial No UA site listed — international referral required	— unknown	— unknown	self-pay: ₴0/course	Trial sponsor

Cost information is orientation. Verify with a specific pharmacy / foundation / trial site. Status updated: 2026-07-15.

plan_id: PLAN-VERIFIED-NPC-L1-NPC_1L_METASTATIC_GC_PD1-V1 | version: 1 | generated: 2026-07-15T13:33:22.953645+00:00

Per FDA non-device CDS positioning (CHARTER §15): Outpatient oncology treatment planning to support tumor-board discussion. Not a medical device; not for autonomous clinical decision-making.

Per FDA non-device CDS positioning (CHARTER §15): Both treatment options below are presented for review. The engine's selection of a 'recommended' default does not constitute a clinical decision. Final treatment selection requires HCP judgment incorporating information not available to the system.

This document is an informational resource supporting tumor-board discussion (per CHARTER §11). It is not a system that makes clinical decisions. Every recommendation must be verified by the treating physician.