PD-1/PD-L1 inhibitors for locally advanced nasopharyngeal carcinoma: a systematic review and meta-analysis based on randomized controlled trials

Cancer research · Nasopharyngeal carcinoma

PD‑1 inhibitors combined with concurrent chemoradiotherapy improve disease control—progression‑free and event‑free survival—as well as reduce recurrence and metastasis in locally advanced nasopharyngeal carcinoma, but overall survival benefit remains uncertain and the risk of immune‑related adverse events increases.

The treatment of locally advanced nasopharyngeal carcinoma (LA‑NPC) is challenged by recurrence and metastasis (R/M). Although concurrent chemoradiotherapy (CRT) is the standard regimen, new strategies are urgently needed to improve patient prognosis. Recent evidence suggests that PD‑1/PD‑L1 inhibitors may offer therapeutic benefit; however, systematic evidence on their efficacy and safety in LA‑NPC remains limited. We conducted a systematic review and meta‑analysis of randomized controlled trials assessing PD‑1 or PD‑L1 inhibitors combined with CRT versus CRT alone in LA‑NPC patients. Two RCTs (n = 575) were included. Meta‑analytic results indicated a significant improvement in progression‑free survival (HR = 0.40, 95% CI 0.18–0.89) and event‑free survival (HR = 0.59, 95% CI 0.38–0.92). Additionally, the combined therapy reduced distant metastasis (OR = 0.50, 95% CI 0.30–0.85) and locoregional recurrence (OR = 0.43, 95% CI 0.22–0.81). No significant difference was observed in overall survival (HR = 0.83, 95% CI 0.48–1.43). However, the risk of immune‑related adverse events increased markedly (OR = 11.14, 95% CI 7.79–15.93). The current evidence, drawn from limited data, underscores the potential of PD‑1 inhibitors but also highlights the need for larger, high‑quality trials to confirm efficacy and safety.

In advanced locoregional nasopharyngeal carcinoma, propelling disease control is critical to prolong survival, yet mandatory consolidation with systemic immunity modulation has not been conclusively proven. This meta‑analysis suggests that adding PD‑1 blockade to standard CRT confers meaningful improvements in progression‑free and event‑free survival while curbing recurrence and metastasis. However, overall survival remains unproven, and immune‑related toxicities are markedly higher, underscoring the clinical trade‑offs of this therapeutic approach.

Evidence level: Számítógépes vagy elméleti. Modellből vagy adatbányászatból származó jel.

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