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

Curative-intent treatment is recommended for medically fit patients with de novo metastatic nasopharyngeal carcinoma who have no more than three metastatic lesions in two or fewer organs at baseline or after response.

• Why it matters: De novo metastatic nasopharyngeal carcinoma was historically treated with palliative intent, but potent systemic therapy plus local treatment has enabled long-term survival in some patients.
• What they did: An international consensus guideline was developed by 54 experts from 46 centres across 18 countries or regions, endorsed by 17 oncology organisations, producing 32 recommendations across seven clinical domains.
• The result: The guideline recommends multimodality care—immunochemotherapy, locoregional radiotherapy, metastasis-directed therapy, and maintenance therapy—providing a framework to standardize management and identify evidence gaps.