**5.3 Treatment in advanced NPC**

Although chemotherapy concurrently with radiation has resulted in many improvements with significant outcomes in NPC patients, and improve survival in locally advanced NPC over 5 years in 50-70%. A large proportion of patients have relapsed either locally or in distant sites, or both. Adding more chemotherapy drugs to available protocols is not a viable approach as CRT already exhibits significant toxicity. Instead, more research aims to identify the possibility of recurrence or relapse before treatment or at the end of the CRT assessment, who can focus on additional research methods. Second, the use of personalized target therapy in conjunction with radiation therapy or chemotherapy is assessed.

In NPC patients, the epidermal growth factor receptor (EGFR) overexpression is 80% or more and associated with lower survival results [73]. Adding of cetuximab, a monoclonal chimeric antibody in patients with squamous cell carcinoma of the head and neck against EGFR in conjunction with RT of HNSCC in locally advanced stages, which reported improvement and significant in OS in comparison to RT alone [74]. The evaluation of cetuximab in concurrent with radiation therapy in comparison to standard CRT in NPC patients has not proven to be more effective due to the association with increased rates of mucositis [75]. The combination of IMRT radiation therapy and weekly cisplatin with cetuximab was more effective in patients in advanced stages [76].
