Capecitabine combined with immunotherapy as maintenance therapy improves survival in recurrent/metastatic nasopharyngeal carcinoma: a retrospective cohort study.

BACKGROUND

We evaluated the clinical impact of combining capecitabine with immunotherapy (Immu/Cape) compared to immunotherapy monotherapy (Immu) as maintenance in recurrent/metastatic (R/M) nasopharyngeal carcinoma (NPC) patients following initial chemo-immunotherapy.

METHODS

We retrospectively analyzed 257 R/M NPC patients who achieved disease control after chemo-immunotherapy and received either Immu/Cape or Immu maintenance. Propensity score matching (PSM) was performed to balance baseline characteristics. Endpoints included progression-free survival (PFS) and overall survival (OS).

RESULTS

Following PSM, the Immu/Cape group exhibited prolonged PFS (median, 27.87 vs 8.5 months, p = 0.016) and OS (3-year rate, 80.8% vs. 65.4%; p = 0.027). This survival benefit was most pronounced in patients with high-burden disease: >5 metastatic lesions, ≥2 involved organs, or detectable post-treatment EBV DNA. The primary toxicity was hand-foot syndrome, with a higher incidence in the Immu/Cape group (53.7% vs. 9.8%; p < 0.001), including 12.2% grade 3-4 events; other severe adverse events were comparable.

CONCLUSION

This study provides hypothesis-generating evidence that Immu/Cape maintenance may improve survival in R/M NPC, especially for high-risk patients. Prospective, randomized trials are required to validate this strategy before it can be considered practice-changing.