Nasopharyngeal cancer (NPC) is a significant healthcare burden in endemic areas and Epstein–Barr virus (EBV) infection plays a crucial role in pathogenesis. The management has evolved in the past decades to transform this once very deadly cancer to a highly treatable one. Advances in radiation therapy (RT) technique and systemic treatment have substantially improvedthe treatment outcome. Although the prognosis of early NPC is favorable, long-term toxicity and quality of life issues continue to be the major problems of survivorship. On the other hand, patients with locoregionally advanced disease still suffer from a considerable rate of treatment failure and the prognosis is extremely poor for those with distant metastasis. Future research should focus on risk-adapted treatment strategies in order to achieve the ultimate goal of personalized medicine. Immunotherapy is an exciting area to explore and the results of ongoing studies are eagerly awaited.