ArticleThe oncologist2025
Anti-PD-1 antibody with or without capecitabine as maintenance therapy after first-line therapy of recurrent or metastatic nasopharyngeal carcinoma.
Article in The oncologist, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
backgroundThe use of maintenance therapy for recurrent or metastatic nasopharyngeal carcinoma (RM-NPC) following first-line treatment with gemcitabine, cisplatin, and anti-PD-1 antibody remains controversial. Therefore, an effective and low-toxicity maintenance treatment option is urgently needed.
methodsThis retrospective study included 301 patients who received either combined maintenance therapy (anti-PD-1 antibody plus capecitabine) or anti-PD-1 antibody alone. Patients were matched in a 1:3 ratio using propensity score matching (PSM). Progression-free survival (PFS) was the primary outcome, and its association with maintenance therapy was assessed using the log-rank test and Cox proportional hazards model.
resultsFifty-eight patients were included in the combined maintenance therapy group. After PSM, 174 patients were included in the anti-PD-1 antibody maintenance therapy group. In the matched cohort, the 2-year PFS rate was significantly higher in the combined maintenance therapy group than in the anti-PD-1 antibody monotherapy group (66.8% vs. 51.3%, P = .0063). Subgroup analysis showed that patients with pre-treatment Epstein-Barr virus (EBV) DNA > 12 400 copies/mL and undetectable post-treatment levels had significantly improved PFS with combined maintenance therapy (hazard ratio [HR] = 0.44, 95% confidence interval [CI] = 0.20-0.96, P = .033). In contrast, no statistically significant PFS improvement from the combined maintenance therapy was observed among patients with low pre-treatment EBV DNA (≤12 400 copies/mL) and undetectable post-treatment levels (HR = 0.59, 95% CI = 0.27-1.27, P = .17), or those with detectable post-treatment EBV DNA levels regardless of pre-treatment levels (HR = 0.73, 95% CI = 0.31-1.70, P = .46). Combined maintenance therapy was associated with higher rates of grade 3-4 hand-foot syndrome (P < .001) and leukopenia (P = .0487).
conclusionsAnti-PD-1 antibody plus capecitabine maintenance therapy improved PFS with manageable toxicities in patients with RM-MPC following first-line immunochemotherapy, particularly in those with pre-treatment EBV DNA >12 400 copies/mL and undetectable post-treatment levels.
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