ArticleBMC cancer2026
Efficacy of PD-1 inhibitor plus induction chemotherapy for nasopharyngeal carcinoma with high-grade extranodal extension: a multicenter retrospective analysis.
Article in BMC cancer, 2026. 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
backgroundsHigh-grade radiologic extranodal extension (G2/3-rENE) is a well-established adverse prognostic factor in nasopharyngeal carcinoma (NPC), as demonstrated in our previous research. This study aims to evaluate the efficacy and safety of combining a PD-1 inhibitor with induction chemotherapy (IC) in this high-risk patient population.
methodsWe retrospectively analyzed 217 histologically confirmed non-metastatic NPC patients from three centers. Group A (n = 104) received IC plus anti-PD-1 therapy followed by concurrent chemoradiotherapy (CCRT), while Group B (n = 113) received IC alone followed by CCRT. Clinical response rates, survival outcomes, and treatment-related toxicities were compared, and subgroup analyses were performed.
resultsPost-IC, Group A demonstrated superior clinical outcomes compared to Group B, with a significantly higher complete response rate (CRR: 21.15% vs. 7.96%, p = 0.001) and objective response rate (ORR: 97.12% vs. 88.50%, p = 0.001). Furthermore, the combination group showed markedly improved rates of 2-year progression-free survival (PFS: 93.2% vs. 81.0%) and distant metastasis-free survival (DMFS: 97.1% vs. 84.8%). Subgroup analyses revealed that patients with baseline EBV DNA < 400 IU/mL, LDH < 2×ULN, T3–4 or N2-3 stage, stage IVa disease, and G3-rENE benefited more from combined treatment. Post-treatment immune profiling revealed reduced total lymphocyte counts with decreased CD4⁺and increased CD8⁺T cells, resulting in a lower CD4⁺/CD8⁺ratio. Morover, patients exhibiting a less pronounced decrease in this ratio were more likely to achieve a complete response.
conclusionsPD-1 blockade with IC significantly improves disease control in high-risk NPC patients with G2/3-rENE. T cell subset dynamics may help predict treatment response, supporting the incorporation of immunotherapy regimens as frontline treatment for this patient population.
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