For patients with locally advanced nasopharyngeal carcinoma, a combination of chemotherapy and immunotherapy shows significant promise in improving long-term outcomes, according to a recent study. Nasopharyngeal carcinoma, a cancer of the upper throat behind the nose, can be particularly challenging to treat, but fresh research suggests a way to enhance current therapies.
Researchers found that adding the immunotherapy drug camrelizumab to standard chemoradiotherapy significantly improved progression-free survival in patients with high-risk nasopharyngeal carcinoma. The multi-center, randomized trial, conducted across seven hospitals in China, involved 390 patients aged 18 to 70. Participants were either given standard chemoradiotherapy or that treatment plus camrelizumab, administered every three weeks for 19 cycles.
Nearly Half Reduction in Risk of Disease Progression
After a median follow-up of nearly 40 months, the study demonstrated a substantial benefit for those receiving camrelizumab. The three-year progression-free survival rate was 83.4% in the camrelizumab group, compared to 71.3% in the standard treatment group. This translates to a roughly 49% reduction in the risk of disease progression, with a hazard ratio of 0.51 (95% CI 0.34 to 0.77; P = .001). The findings, published in The BMJ, suggest a new avenue for improving treatment efficacy.
While overall survival showed a trend toward improvement in the camrelizumab group (94.8% vs. 92.2%), the difference was not statistically significant at this stage of follow-up (hazard ratio, 0.59; 95% CI, 0.27 to 1.28; P = .19). Researchers note that longer follow-up is needed to assess the impact on overall survival.
The study also revealed improvements in both distant metastasis-free survival and locoregional relapse-free survival. The rate of distant metastasis at 36 months was 88.9% in the camrelizumab group versus 80.7% in the standard treatment group (hazard ratio, 0.54; P = .02). Similarly, locoregional relapse-free survival was 92.8% with camrelizumab compared to 83.2% with standard treatment (hazard ratio, 0.38; P = .001).
The addition of camrelizumab did not appear to significantly increase severe side effects. Grade 3 or 4 adverse events occurred in 50.5% of patients treated with camrelizumab, compared to 48.7% in the standard treatment group. Severe immunological adverse events (grade 3 or 4) were reported in 10.2% of patients receiving camrelizumab, while severe late complications were observed in 3.2% of the experimental group and 3.7% of the control group.
Interestingly, the study found that the improvement in progression-free survival wasn’t linked to a higher initial complete response rate. Complete response rates were similar between the two groups (90.2% vs. 90.3%), suggesting that camrelizumab’s benefit comes from improved control of the disease over the medium term.
These results support the integration of anti-PD1 immunotherapy, such as camrelizumab, into the treatment strategy for high-risk nasopharyngeal carcinoma, particularly in patients who don’t respond fully to initial chemotherapy or who continue to have detectable Epstein-Barr virus (EBV) DNA after induction. The National Comprehensive Cancer Network (NCCN) guidelines already recognize gemcitabine and cisplatin induction chemotherapy followed by concurrent chemoradiotherapy as a standard approach for this cancer. Further research is planned to confirm the effect on overall survival and to better understand the long-term benefits and risks.
(1) National Comprehensive Cancer Network. Clinical Practice Guidelines in Oncology: Head and Neck Cancers, version 1.2020
(2) You R, Xu GQ, Ding X, et al. Standard chemoradiotherapy with concurrent and adjuvant camrelizumab in patients with high risk nasopharyngeal carcinoma: multicentre, randomised, open label, phase 3Â trial. The BMJ. 2026;392:e085863
