Watch-and-wait strategy in patients with objective response after immuno-chemotherapy for locally recurrent nasopharyngeal carcinoma: a pilot study

• Published in: BMC cancer Vol. 25; no. 1; pp. 1255 - 9
• Main Authors: Zhang, Quxia, Huang, Wanfang, Chen, Xinlan, Yan, Zhiwei, Huang, Daqiang, Xu, Hanchuan, Zheng, Yahan, Zhu, Lili, Pan, Caizhu, Pan, Jianji, Lin, Shaojun, Huang, Chaobin, Guo, Qiaojuan
• Format: Journal Article
• Language: English
• Published: England BioMed Central Ltd 01.08.2025; BioMed Central; BMC
• Subjects: Adverse events; Cancer; Carcinoma; Care and treatment; Censorship; Chemotherapy; Chemotherapy, Combination; Clinical trials; Disease control; Evaluation; Immune checkpoint inhibitors; Immuno-chemotherapy; Immunotherapy; Locally recurrent nasopharyngeal carcinoma; Low-intensity maintenance treatment; Methods; Nasopharyngeal cancer; Nasopharyngeal carcinoma; Patient outcomes; Patients; Radiation therapy; Remission; Surgery; Survival; Toxicity; Tumors; Watch-and-wait strategy; Watchful waiting (Medical care); China; Immuno-chemotherapy; Watch-and-wait strategy; Low-intensity maintenance treatment; Locally recurrent nasopharyngeal carcinoma
• ISSN: 1471-2407; 1471-2407
• DOI: 10.1186/s12885-025-14647-2

Objectives The decision on trade-off between the chance of salvage and the risk of serious toxicity in locally recurrent nasopharyngeal carcinoma (lrNPC) is a dilemma both to the clinician and patients. This study aimed to evaluate the efficacy of our watch-and-wait (W-W) strategy by receiving low-intensity maintenance treatment (LIMT) in lrNPC patients who achieved objective response after immune checkpoint inhibitors plus chemotherapy (ICI-chemotherapy), and explore the possibility of sparing or delaying local treatment. Methods LrNPC patients who were treated in our institution from January 2022 to May 2023 were candidates for this study. All enrolled patients would receive protocolized ICI-chemotherapy followed by LIMT alone (W-W approach) without immediate local treatment. The objective response rate (ORR), progression free survival (PFS), overall survival (OS) and safety profile were evaluated. Results Twenty-six lrNPC patients were included, 18 patients (69.2%) achieved objective response after ICI-chemotherapy, and continued with LIMT, 17 of them (17/18, 94.4%) maintained a state of disease remission without requiring local treatment, only one patient experienced PD during LIMT. Six patients remained in SD at the completion of ICI-chemotherapy, two patients experienced PD during ICI-chemotherapy. The 2-year OS and PFS were 87.8% and 64.0%, respectively. Reported adverse events were all manageable and no severe treatment-emergent adverse event were detected. Conclusions For patients achieving response after ICI-chemotherapy, a "W-W" approach by continuing with LIMT, eschewing immediate local therapy, may be a viable option. Well-designed, prospective trials with conventional approaches involving earlier local treatment in comparison are essential to confirm the benefit of this innovative approach. Keywords: Locally recurrent nasopharyngeal carcinoma, Watch-and-wait strategy, Immuno-chemotherapy, Low-intensity maintenance treatment