Immunotherapy plus induction chemotherapy followed by radiotherapy alone or one cycle of concurrent chemotherapy with cisplatin vs induction chemotherapy followed by two cycles of concurrent chemotherapy with cisplatin in locoregionally advanced nasopharyngeal carcinoma

ObjectiveTo compare the efficacy and safety of immunotherapy combined with induction chemotherapy followed by radiotherapy alone or one cycle of concurrent chemoradiotherapy with cisplatin versus induction chemotherapy followed by two cycles of concurrent chemoradiotherapy with cisplatin in patients with locally advanced nasopharyngeal carcinoma.MethodsA total of 173 patients with locally advanced nasopharyngeal carcinoma treated at our hospital from November 2019 to September 2024 were retrospectively analyzed. Patients received induction therapy with immunotherapy (toripalimab or tislelizumab) combined with chemotherapy (TPC or GP) followed by radiotherapy alone or one cycle of concurrent chemoradiotherapy with cisplatin (immunochemotherapy group).

Patients received TPC or GP induction chemotherapy followed by 2 cycles of concurrent chemoradiotherapy with cisplatin (IC-CCRT group). Immunotherapy was given on day 1 of each cycle of induction therapy.

The efficacy and toxicities of the two groups were evaluated.ResultsAfter induction therapy, 20 patients (29.4%) in the immunochemotherapy group and 15 patients (14.3%) in the IC-CCRT group achieved complete remission (p=0.02). At a median follow-up of 27.5 months, recurrence or metastasis occurred in 7.4%(5/68) of the patients in the immunochemotherapy group and 19.0%(20/105) of those in the IC-CCRT group.

The 2-year event-free survival (EFS), overall survival (OS), locoregional recurrence-free survival (LRRFS) and distant metastasis-free survival (DMFS) in the immunochemotherapy group were 93.5% vs 81.1% (p=0.03), 100.0% vs 97.9% (p=0.3), 96.9% vs 91.4% (p=0.2), 95.0% vs 88.2% (p=0.1) compared with the IC-CCRT group. There were 28 cases (41.1%) in the immunochemotherapy group and 58 cases (55.2%) in the IC-CCRT group experienced grade 3–4 acute adverse events.

In the immunochemotherapy group, 4 patients developed grade 3–4 immune-related adverse events.ConclusionsCompared with induction chemotherapy followed by two cycles of concurrent chemoradiotherapy with cisplatin, immunotherapy combined with induction chemotherapy followed by radiotherapy alone or one cycle of concurrent chemoradiotherapy with cisplatin may improve the EFS of patients with locally advanced nasopharyngeal carcinoma with low adverse events. However, this data requires prospective randomized controlled studies to be confirmed in the future.