From Evidence to Practice: Integrating Toripalimab into Frontline Care for Recurrent Locally Advanced or Metastatic Nasopharyngeal Carcinoma - Episode 7
Panelists discuss the efficacy of multiple PD-1 inhibitors studied in nasopharyngeal cancer (NPC), noting similar overall outcomes despite differences in trial designs and adverse effect profiles, challenges in direct comparisons due to crossover and varying chemotherapy backbones, and how limited US approvals impact clinical choice—yet collectively these data affirm the integral role of PD-1 blockade as a cornerstone of treatment.
Multiple PD-1 inhibitors have been studied in nasopharyngeal cancer NPC, with at least seven 7 agents showing efficacy in randomized trials. Although differences in trial design and patient populations make direct comparisons difficult, overall response rates and survival outcomes appear fairly similar across these drugs. Some variations in side adverse effect profiles exist; for example, one agent is known for causing a distinct painful skin reaction. Differences in binding affinity to the PD-1 receptor may suggest potential variations in effectiveness, with some agents demonstrating higher affinity, but no definitive head-to-head data is are available yet to favor one over another.
One recently approved PD-1 inhibitor outside the U.S. US was evaluated in a trial including both carboplatin and cisplatin-based chemotherapy combinations, showing a median progression-free survival of 9.6 months versus vs 7 months in the control arm. Although it did not meet its primary end point, the overall data were comparable to other PD-1 inhibitor studies. However, this agent currently lacks U.S. US availability, leaving one PD-1 inhibitor as the only FDA-approved option domestically. Clinicians have sometimes used other PD-1 inhibitors off-label while awaiting broader access, but comfort and familiarity often influence the choice of agent in clinical practice.
Interpreting survival outcomes across trials is complicated by factors such as crossover design, where patients in control arms may receive PD-1 inhibitors after progression, affecting long-term survival curves. Adjustments for crossover effects have been necessary in some studies to clarify the true impact of these drugs. Despite these challenges, the consistent survival benefits observed support the strong role of PD-1 inhibition in nasopharyngeal cancer NPC treatment, reinforcing the importance of incorporating immunotherapy as a key part of standard care.