The role of immunochemotherapy maintenance in metastatic nasopharyngeal carcinoma: insights from a cohort study in an endemic region

IF 3.8 2区医学 Q2 IMMUNOLOGY

Clinical & Translational Immunology Pub Date : 2025-07-02 DOI:10.1002/cti2.70043

Zhuoying Luo, Yue Xia, Yuping Zhao, Haoyang Huang, Ying Deng, Zejiang Zhan, Yingying Huang, Xun Cao, Xi Chen, Jiayu Zhou, Chixiong Liang, Weixiong Xia, Liangru Ke, Xuehua Wei, Jinling Duan, Xing Lv, Hu Liang

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引用次数: 0

Abstract

Objectives

Metastatic nasopharyngeal carcinoma (mNPC) following palliative chemotherapy has high incidence and mortality rates. While maintenance therapy shows promising potential, the optimal strategy remains undefined. This study aimed to evaluate the therapeutic efficacy of immunochemotherapy maintenance in patients with mNPC.

Methods

This cohort study evaluated the therapeutic efficacy of combined maintenance therapy with capecitabine and anti-PD-1 antibodies in mNPC patients, using a prospectively maintained database. The primary endpoint was progression-free survival (PFS), and secondary endpoints included overall survival and safety profile. Furthermore, stratification analysis and sensitivity analysis were performed.

Results

The study included 300 mNPC patients treated at Sun Yat-sen University Cancer Center from 2018 to 2023. Two hundred and thirty-four patients (78.0%) were male, and the median age was 45 years [interquartile range (IQR): 36–54]. At median follow-up of 43.6 months (IQR: 31.8–57.8), combination maintenance significantly improved PFS compared to single-drug maintenance [weighted hazard ratio (HR) 0.580, 95% confidence interval (95% CI) 0.387–0.872, P = 0.009; E-value, 2.27]. Stratification analysis revealed enhanced efficacy of immunochemotherapy maintenance in patients without prior local treatment (HR 0.414, 95% CI 0.224–0.767, P = 0.005) or with elevated premaintenance Epstein–Barr virus (EBV) DNA levels (HR 0.063, 95% CI 0.007–0.548, P = 0.012). No significant difference in PFS was observed between the capecitabine and anti-PD-1 single-agent groups. Notably, combination therapy yielded significantly longer PFS than either single-drug regimen. The safety profile was similar between combination maintenance and single-drug groups.

Conclusions

Combined maintenance therapy with anti-PD-1 antibodies and capecitabine may be a feasible treatment strategy for mNPC patients.

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免疫化疗维持在转移性鼻咽癌中的作用：来自一个流行地区队列研究的见解

目的姑息性化疗后转移性鼻咽癌（mNPC）的发病率和死亡率较高。虽然维持治疗显示出良好的潜力，但最佳策略仍未确定。本研究旨在评价免疫化疗维持治疗mNPC患者的疗效。方法本队列研究使用前瞻性维护的数据库，评估卡培他滨和抗pd -1抗体联合维持治疗mNPC患者的疗效。主要终点是无进展生存期（PFS），次要终点包括总生存期和安全性。并进行分层分析和敏感性分析。该研究纳入了2018年至2023年在中山大学癌症中心接受治疗的300例mNPC患者。男性234例（78.0%），中位年龄45岁[四分位间距（IQR）： 36-54岁]。中位随访43.6个月（IQR: 31.8 ~ 57.8），联合维持较单药维持显著改善PFS[加权风险比（HR） 0.580, 95%可信区间（95% CI） 0.387 ~ 0.872, P = 0.009；创造价值,2.27]。分层分析显示，未接受过局部治疗的患者（HR 0.414, 95% CI 0.244 - 0.767, P = 0.005）或维持前eb病毒（EBV） DNA水平升高的患者（HR 0.063, 95% CI 0.007-0.548, P = 0.012）维持免疫化疗的疗效增强。卡培他滨与抗pd -1单药组间PFS无显著差异。值得注意的是，联合治疗的PFS明显长于单药治疗。联合维持组和单药组的安全性相似。结论抗pd -1抗体联合卡培他滨维持治疗可能是mNPC患者的一种可行的治疗策略。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Clinical & Translational Immunology Medicine-Immunology and Allergy

CiteScore

12.00

自引率

1.70%

发文量

审稿时长

13 weeks

期刊介绍： Clinical & Translational Immunology is an open access, fully peer-reviewed journal devoted to publishing cutting-edge advances in biomedical research for scientists and physicians. The Journal covers fields including cancer biology, cardiovascular research, gene therapy, immunology, vaccine development and disease pathogenesis and therapy at the earliest phases of investigation.