⁃ Each patient eligible to participate in this study must meet all the following criteria:

• Able to provide written informed consent and can understand and agree to comply with the requirements of the study and the schedule of assessments.

• Age ≥21 years on the day of signing the ICF

• Fulfil one of the following three scenarios:

‣ Suspected NPC cases, diagnosed clinically based on symptoms (neck swelling, unilateral epistaxis, nasal obstruction etc.)

⁃ Newly-diagnosed, histologically confirmed NPC patients with Stages 2-4A disease based on the AJCC/UICC 8th Edition TNM stage classification

⁃ Newly-diagnosed patients with RM-NPC

• All confirmed NPC patients must meet these additional criteria before they can continue participation in the study:

• NPC associated with EBV infection, determined as:

‣ The presence of EBV has been confirmed in the tumour by immunohistochemistry for EBV antigens or in situ hybridization for EBV early RNA (EBER), or

⁃ NPC occurred in association with a raised serum titre of IgA to EBV viral capsid antigen (VCA) or early antigen (EA) in a patient living in endemic area of high incidence of EBV+ undifferentiated NPC, or

⁃ NPC in the context of an elevated circulating EBV genome level

• AJCC 8th edition stage 2-4A or RM NPC based on the following diagnostic workup:

‣ Evaluation of tumour extent with magnetic resonance imaging (MRI) of the nasopharynx and neck. If MRI is medically contraindicated, computed tomography (CT) scan with ≤3 mm and intravenous contrast is acceptable.

⁃ Distant metastasis staging:

• CT scan with contrast of the chest, abdomen, and pelvis or a total body 18F-Fluorodeoxygenase positron emission tomography CT (18F-FDG-PET-CT) scan;

∙ Bone scan, if a 18F-FDG-PET-CT scan is not performed.

• ECOG Performance Status ≤1

• Adequate organ function