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Immune checkpoint inhibitor combined with chemotherapy versus chemotherapy alone in the first-line treatment for recurrent or metastatic nasopharyngeal carcinoma: a meta-analysis of random controlled trials

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Abstract

Purpose

Immune checkpoint inhibitor (ICI) monotherapy and chemotherapy (CT) have been used to treat recurrent or metastatic nasopharyngeal carcinoma (R/M-NPC), with demonstrated survival benefits and good safety. However, whether combination therapy is superior to CT alone remains unclear. We summarized the existing evidence comparing the effectiveness and toxicities of ICI combined with CT versus CT alone.

Methods

Online databases was conducted for eligible randomized controlled trials (RCTs) published up to November 1, 2023. Progression-free survival (PFS) and overall survival (OS) were the primary endpoint. Objective response rates (ORRs) and adverse events (AEs) were the secondary endpoint.

Results

Three randomized controlled trials (Capture-1st, JUPITER-02, and RATIONALE-309) were included. First-line ICI therapy combined with CT showed significant improvement in PFS (hazard ratio[HR], 0.53; 95% confidence interval[CI]: 0.44–0.64), OS (HR, 0.63;95%CI: 0.49–0.81) and ORRs (odds ratio[OR], 1.79;95%CI: 1.30–2.46), when compared with CT alone. AEs ≥ grade 3 during treatment and treatment-related deaths were not significantly different between the two groups.

Conclusions

In patients with R/M-NPC, ICI therapy combined with CT showed improved ORRs, PFS, and OS, with similar safety as CT alone.

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Abbreviations

R/M-NPC:

Recurrent or metastatic nasopharyngeal carcinoma

ICI:

Immune checkpoint inhibitor

CT:

Chemotherapy

RCT:

Randomized controlled trial

ORR:

Objective response rate

PFS:

Progression-free survival

OS:

Overall survival

AE:

Adverse event

EBV:

Epstein-Barr virus

IMRT:

Intensity-modulated radiotherapy

PD-1:

Programmed cell death protein-1

PD-L1:

Programmed cell death 1 ligand 1

DOR:

Duration of response

CIs:

Confidence intervals

HR:

Hazard ratio

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Acknowledgements

For improving the final version of the manuscript, we are grateful to the comments provided by reviewers and the editor, which were of great value. Thank you for the language assistance provided by Editage.

Funding

This work was supported by grants from the National Natural Science Foundation of China (No. 82272736,82160467,81460460,81760542), the Research Foundation of the Science and Technology Department of Guangxi Province, China (grant No. 2023GXNSFDA026009, 2016GXNSFAA380252, 2018AB61001 and 2014GXNSFBA118114), the Research Foundation of the Health Department of Guangxi Province, China (No.S2018087), Guangxi Medical University Training Program for Distinguished Young Scholars (2017), Medical Excellence Award Funded by the Creative Research Development Grant from the First Affiliated Hospital of Guangxi Medical University (2016). Guangxi Medical High-level Talents Training Program. The central government guide local science and technology development projects (ZY18057006).

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Authors and Affiliations

  1. Department of Radiation Oncology, The First Affiliated Hospital of Guangxi Medical University, Nanning, 530021, Guangxi, China

    Shuangyue Wang, Rong Li, Ziyan Zhou & Min Kang

  2. Guangxi Tumor Radiation Therapy Clinical Medical Research Center, Nanning, 530021, Guangxi, China

    Shuangyue Wang, Rong Li, Ziyan Zhou & Min Kang

  3. Guangxi Key Laboratory of Immunology and Metabolism for Liver Diseases, Nanning, 530021, Guangxi, China

    Shuangyue Wang, Rong Li, Ziyan Zhou & Min Kang

  4. Key Laboratory of Early Prevention and Treatment for Regional High Frequency Tumor (Guangxi Medical University), Ministry of Education, Nanning, 530021, Guangxi, China

    Shuangyue Wang, Rong Li, Ziyan Zhou & Min Kang

  5. Department of Oncology, The 923 Hospital of People’s Liberation Army, Nanning, 530021, Guangxi, China

    **aojie Huang

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Contributions

(i) Conception and design: SW and MK; (ii) Administrative support: MK; (iii) Collection and selection of data: SW, XH; (iv) Data analysis and interpretation: ZZ, RL; (v) Manuscript writing: all authors; (vi) Final approval of manuscript: all authors.

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Correspondence to Min Kang.

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Wang, S., Huang, X., Li, R. et al. Immune checkpoint inhibitor combined with chemotherapy versus chemotherapy alone in the first-line treatment for recurrent or metastatic nasopharyngeal carcinoma: a meta-analysis of random controlled trials. Eur Arch Otorhinolaryngol (2024). https://doi.org/10.1007/s00405-024-08768-w

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