Patients with de novo metastatic nasopharyngeal carcinoma were historically deemed incurable and treated with palliative intent. Emergence of potent systemic therapy in combination with local treatment for both locoregional and metastatic diseases has enabled long-term survival in some patients. This international guideline was developed through consensus-building by 54 experts from 46 centres across 18 countries or regions and endorsed by 17 oncology organisations. 32 recommendations across seven clinical domains were formulated, including 29 strong (≥80% agreement [consensus] or high quality of evidence) and three conditional recommendations (67-79% agreement). We recommend that curative-intent treatment should be offered to medically fit patients with no more than three metastatic lesions in two or fewer organs at baseline or following response to systemic therapy; multimodality treatment (comprising immunochemotherapy, locoregional radiotherapy, metastasis-directed therapy, and maintenance therapy) is recommended. This guideline provides a practical framework for standardisation of clinical management of de novo metastatic nasopharyngeal carcinoma and identification of key evidence gaps for future research.

Up to 12% of childhood cancer survivors have an underlying cancer predisposition syndrome (CPS). As a result, these childhood cancer survivors are at increased risk for developing and succumbing to subsequent malignant neoplasms. Identifying childhood cancer survivors with CPS is essential to improving overall outcomes by informing tailored approaches to cancer screening, treatment, and, for some, risk-reducing interventions. Despite these potential benefits, it is often unclear which childhood cancer survivors warrant referral for genetic counselling and germline genetic testing. Using an evidence-based approach, a standardised guideline for referral for cancer genetics evaluation of childhood cancer survivors at high risk of having a CPS was developed and incorporated into the Children's Oncology Group Long-Term Follow-Up Guidelines for Survivors of Childhood, Adolescent, and Young Adult Cancers. This Policy Review details the importance, development, and anticipated impact of this new guideline. Raising awareness of this guideline is crucial to enhancing the integration of genetics into survivorship care and improving health outcomes for childhood cancer survivors with CPS.