Comparison of ≥2 lines immunotherapy regimens for recurrent/metastatic nasopharyngeal carcinoma

Patients with recurrent/metastatic nasopharyngeal carcinoma (RM-NPC) do not yet have a strong recommended regimen after failure of first-line systemic therapy. This study retrospectively analyzed the efficacy of immunotherapy regimens in RM-NPC that failed at least first-line therapy. From February 2014 to August 2023, a total of 794 patients with RM-NPC were included in this study, of which 75 patients received anti-programmed cell death protein-1 (PD-1) only (P), 130 patients received anti-PD-1 plus antiangiogenic therapy (AP), 210 patients received anti-PD-1 plus single-agent chemotherapy (C1P), 276 patients received anti-PD-1 plus two-agent chemotherapy (C2P), and 103 patients received anti-PD-1 plus antiangiogenic plus chemotherapy (CAP). Progression-free survival (PFS), overall survival (OS), and adverse events were analyzed. In the inverse probability of treatment weighting (IPTW) cohort, median follow-up time was 28.7 months, median PFS in the P, AP, C1P, C2P, and CAP were 3.6, 8.5, 7.6, 12.7, and 16.3 months, respectively. PFS was significantly better in the CAP, C2P, C1P, and AP than P (p values of <.001, <.001, .026, and .002). Median OS in the P, AP, C1P, C2P, and CAP were 35.8, 46.6, 50.9, 50.6, and 47.2 months, respectively. Grade 3-4 treatment-related adverse events (TRAEs) occurred in 288 patients, with rates significantly higher in the C1P than AP (34.3% vs. 16.9%) and higher in the C2P than CAP (54.0% vs. 42.7%). These results showed that, in RM-NPC patients who failed at least first-line therapy, anti-PD-1 combination therapy was associated with improved PFS compared with anti-PD-1 monotherapy.