With high local control rates achieved by the use of intensity modulated radiotherapy (IMRT) in NPC, the challenge is to improve distant control by systemic therapies. The current standard of care for stages IIB and above NPC is concurrent cisplatin–IMRT with or without adjuvant cisplatin–5FU. Neoadjuvant chemotherapy followed by chemoradiotherapy (CRT) is being investigated in ongoing randomized phase III trials. Platinum-based doublet chemotherapy is standard first-line therapy in metastatic disease. Molecular therapies targeting EGFR, VEGF, P13K-AKT-mTOR pathways, as well as epigenetic and immunotherapeutic approaches are promising and an overview of ongoing studies will be presented.