Exploring NCCN Guideline Updates and Advancing Immunotherapy Strategies in Nasopharyngeal Carcinoma: With Neal S. Akhave, MD

Welcome to OncLive On Air®! I’m your host today, Jax DiEugenio.

In today’s episode, we spoke with Neal S. Akhave, MD, about recent updates to the National Comprehensive Cancer Network (NCCN) Guidelines for nasopharyngeal carcinoma (NPC) and how these changes are reshaping clinical practice in the United States. Dr Akhave is an assistant professor in the Department of Thoracic/Head and Neck Medical Oncology of the Division of Cancer Medicine at The University of Texas MD Anderson Cancer Center in Houston.

In our conversation, Dr Akhave discussed the addition of toripalimab (Loqtorzi), a PD-1 inhibitor, to the NCCN guidelines following its launch in the United States. Supported by data from the phase 3 JUPITER-02 trial (NCT03581786), toripalimab is now incorporated into frontline therapy for patients with recurrent metastatic or de novo metastatic Epstein–Barr virus (EBV)–positive NPC, in combination with gemcitabine and cisplatin. He explained how this regimen has produced substantial improvements in progression-free survival (PFS), nearly tripling median PFS compared with chemotherapy alone, while maintaining a manageable safety profile.

Dr Akhave also reviewed findings from the phase 3 DIAMOND trial (NCT04907370), which evaluated the integration of toripalimab into induction chemoradiotherapy in the management of locally advanced NPC. In this study, replacing concurrent cisplatin with toripalimab plus radiation preserved efficacy while reducing acute toxicities—including mucositis, nausea, and dermatitis—and improving patient quality of life. He noted that the benefit of PD-1 blockade in NPC reflects the tumor’s near-universal PD-L1 expression and its biologic responsiveness to chemoimmunotherapy.

Additionally, Dr Akhave highlighted how data from both JUPITER-02 and DIAMOND reinforce the evolving role of immunotherapy across disease stages, with ongoing efforts to optimize sequencing, minimize toxicity, and extend durable responses for patients with NPC.

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