Efficacy and Safety of Re-Challenging PD-1 Inhibitors in Second-Line Treatment in Metastatic Nasopharyngeal Carcinoma Previously Treated with Chemotherapy and PD-1 Inhibitors

• Published in: Cancer management and research Vol. 16; pp. 771 - 780
• Main Authors: Bei, Weixin, Dong, Shuhui, Liu, Guoying, Lin, Lanfeng, Jiang, Yaofei, Lu, Nian, Li, Wangzhong, Liang, Hu, Xiang, Yanqun, Xia, Weixiong
• Format: Journal Article
• Language: English
• Published: New Zealand Dove Medical Press Limited 01.01.2024; Dove; Dove Medical Press
• Subjects: Analysis; Antimitotic agents; Antineoplastic agents; Cancer; Carcinoma; Chemotherapy; Development and progression; Drug therapy; Health aspects; Metastasis; metastatic nasopharyngeal carcinoma; Original Research; pd-1 immune checkpoint inhibitors; Rankings; second-line treatment strategies; China; second-line treatment strategies; PD-1 immune checkpoint inhibitors; chemotherapy; metastatic nasopharyngeal carcinoma
• ISSN: 1179-1322; 1179-1322
• DOI: 10.2147/CMAR.S460716

We aim to evaluate the efficacy and safety of anti-PD1 rechallenge in combination with chemotherapy in patients with metastatic nasopharyngeal carcinoma (mNPC) who have progressed on prior anti-PD1 therapy. We enrolled patients with mNPC who received chemotherapy combined with PD-1 immune-checkpoint inhibitors (ICIs) or chemotherapy alone after prior progression of anti-PD1 therapy. The primary endpoint was progress-free survival (PFS), and the secondary endpoints included overall survival (OS), disease control rate (DCR) and objective response rate (ORR). A total of 96 patients were eligible between January 2015 and December 2020. Thirty-seven (38.5%) were in the PD-1 ICIs re-challenge group, while the remaining 59 patients (61.5%) were in the chemotherapy group. The ORR and DCR of PD-1 ICIs group and chemotherapy group were 37.8% vs 23.7% and 86.5% vs.74.5%, respectively. After a median follow-up period of 21.1 months (IQR 16.1-28.7), the log-rank analysis demonstrated a significantly improved PFS in the PD-1 ICIs re-challenge group compared to the chemotherapy group (8.4 months [95% CI 4.3-14.0] vs 5.0 months [95% CI 2.8-7.2], 0.03). However, no significant difference in OS was observed between the two groups (28.3 vs 24.1 months, 0.09). The two groups had similar adverse reactions, but the incidence of grade 3 or 4 thrombocytopenia was significantly higher in the PD-1 ICIs re-challenge group (18.9% vs 3.4%, 0.025). mNPC patients who progressed from prior anti-PD1 therapy could benefit from the anti-PD1 rechallenge in combination with chemotherapy. However, further validation is needed.