PD-1 Inhibitors Plus Chemotherapy In Recurrent Or Metastatic Nasopharyngeal Carcinoma:A Retrospective Analysis

Objective:1.To compare the short-term and long-term efficacy and safety of PD-1 inhibitors combined with chemotherapy and chemotherapy alone in patients with recurrent or metastatic nasopharyngeal carcinoma(R/M NPC).2.To explore the prognostic factors of patients with R/M NPC.Methods:Based on the inclusion and exclusion criteria,the data of 83 patients with R/M NPC confirmed by pathology or imaging at The First Affiliated Hospital of Nanchang University from January 2019 to December 2021 were retrospectively reviewed.32 patients were included in the study group with PD-1 inhibitor combined with chemotherapy,and 51 patients were included in the control group with chemotherapy alone.The PD-1 inhibitor was Toripalimab or Camrelizumab,and the chemotherapy regimen was platinum-containing double drug combined chemotherapy.Objective response rate(ORR),progression free survival(PFS),overall survival(OS)and toxicities were compared between the study group and the control group.Result:The ORR of the study group was significantly better than that of the control group(65.6% vs 43.1%,P =0.046),and the median PFS of the study group was significantly longer(11.0 months vs 7.5 months,P =0.007).The 2-year OS rates of the study group and the control group were 68.6% and 62.8%,the differences were no statistically significant(P =0.308).Subgroup analysis of the study group showed no statistical difference in the efficacy of different PD-1 inhibitors,and the median PFS of patients treated with first-line therapy in the study group was significantly improved compared with those in second-line treatment,and the difference was statistically significant(18.0 months vs 9.5 months,P =0.034).Univariate analysis of PFS showed that patients with the treatment cycles ≥4 and the regimen of PD-1 inhibitor combined with chemotherapy had longer PFS.Multivariate analysis showed no liver metastasis,the treatment cycles ≥4 and PD-1 inhibitors combined with chemotherapy were independent prognostic factors for improving PFS in patients with R/M NPC(HR=0.509,95 % CI:0.286-0.904,P =0.021;HR=0.315,95 % CI:0.175-0.565,P(27)0.001;HR=0.386,95%CI:0.219-0.683,P =0.001).The incidence of hypothyroidism and reactive capillary hyperplasia in the study group was significantly higher than that in the control group,and there was no statistical difference in hematological toxicity,gastrointestinal reaction and impaired liver function between the two groups.Conclusions:1.PD-1 inhibitors combined with chemotherapy in the treatment of R/M NPC can significantly improve the ORR and median PFS of patients with good safety.2.No liver metastases,the treatment cycles ≥4 and PD-1 inhibitors combined with chemotherapy were independent prognostic factors for improving PFS in R/M NPC.