Efficacy of immunotherapy rechallenge in locoregionally advanced nasopharyngeal carcinoma after progression: A real-world analysis.

BACKGROUND

Recent clinical trials have suggested that incorporating immunotherapy into the treatment of locoregionally advanced nasopharyngeal carcinoma (LA-NPC) may improve survival outcomes. However, for patients who experience disease progression despite immunotherapy, the clinical value of immunotherapy rechallenge as a first-line treatment for recurrent or metastatic disease remains unclear.

METHODS

In this real-world study, patients with LA-NPC who received immunotherapy during the initial treatment and subsequently experienced disease progression were retrospectively analyzed. All patients received first-line treatment with or without immunotherapy rechallenge after progression. The primary endpoint was progression-free survival after the first relapse (PFS-r).

FINDINGS: From a total of 24,183 consecutive patients screened between 2018 and 2023, 160 met the eligibility criteria and were included, with 117 receiving immunotherapy rechallenge and 43 receiving non-immunotherapy treatment after progression. The median follow-up time was 39.3 months (interquartile range, 26.0-48.4). After inverse probability of treatment weighting adjustment, immunotherapy rechallenge did not confer a significant survival advantage in the overall cohort (2-year PFS-r, 40.8% vs. 26.2%; hazard ratio [HR] = 0.677, 95% confidence interval [CI] 0.419-1.094, p = 0.111). Subgroup analyses showed that, in patients with an immunotherapy-free interval >1 year, immunotherapy rechallenge was associated with a significantly improved prognosis (2-year PFS-r, 65.4% vs. 15.5%; HR = 0.210, 95% CI 0.093-0.474, p < 0.001).

CONCLUSIONS

Immunotherapy rechallenge may not provide a significant survival benefit following initial immunotherapy failure in LA-NPC, except in patients with an immunotherapy-free interval exceeding 1 year.

FUNDING: National Natural Science Foundation of China and Science and Technology Program of Guangzhou.