Immunotherapy for locoregionally advanced nasopharyngeal carcinoma: a meta-analysis of randomized clinical trials
The addition of PD‑1 inhibitors to standard cisplatin‑based chemoradiotherapy improves disease control in locoregionally advanced nasopharyngeal carcinoma without added toxicity.
Background: Locoregionally advanced nasopharyngeal carcinoma (LANPC) is the predominant stage at diagnosis and is commonly treated with cisplatin‑based chemoradiotherapy (CRT). Although this approach achieves excellent locoregional control, distant metastasis remains the leading cause of treatment failure. Immunotherapy with programmed cell death protein 1 (PD‑1) inhibitors, supported by the immunogenicity of Epstein‑Barr virus‑associated disease, has emerged as a promising strategy. Objective: To synthesize evidence from phase III trials on the efficacy and safety of PD‑1 blockade combined with definitive chemoradiotherapy in LANPC. Design: Systematic review and meta‑analysis of randomized controlled trials. Methods: Three phase III trials (1237 patients) were identified. Hazard ratios (HRs) for event‑free survival (EFS/FFS), overall survival (OS), distant metastasis‑free survival (DMFS), and locoregional relapse‑free survival (LRFS) were extracted. Results: PD‑1 blockade significantly improved EFS/FFS (HR 0.66, 95% CI 0.49–0.89) and DMFS (HR 0.61, 95% CI 0.43–0.85). LRFS showed a non‑significant trend (HR 0.67). OS data were immature (HR 0.94, 95% CI 0.60–1.48). Severe and fatal adverse events were comparable between groups. Conclusion: PD‑1 blockade combined with cisplatin‑based chemoradiotherapy improves disease control in LANPC without added toxicity. Longer follow‑up is needed to establish OS benefit and optimize treatment strategies.
Adding immunotherapy to standard chemoradiotherapy improves disease control in advanced nasopharyngeal cancer without extra side effects.
Bizonyítékszint: Irányelv / elfogadott gyakorlat. Magas szintű klinikai elfogadottság.
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