SynthesisFrontiers in oncology2026
Efficacy, long-term survival and safety of different PD-1 inhibitors plus chemotherapy in recurrent or metastatic nasopharyngeal carcinoma: a systematic review and meta-analysis.
Synthesis in Frontiers in oncology, 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
Background: Recurrent or metastatic nasopharyngeal carcinoma (RM-NPC) is associated with poor prognosis. PD-1 inhibitors combined with chemotherapy have become the standard first-line treatment, but the comparative efficacy, long-term survival, and safety of different PD-1 inhibitors remain unclear. This study aimed to evaluate the impact of distinct PD-1 inhibitors plus chemotherapy for RM-NPC. Methods: We conducted a systematic review and single-arm meta-analysis including 19 studies with 1459 patients. Outcomes included objective response rate (ORR), disease control rate (DCR), progression-free survival (PFS), overall survival (OS), and grade ≥3 treatment-related adverse events (TRAEs). Pooled analyses and subgroup comparisons stratified by PD-1 inhibitor type were performed. Results: The pooled ORR was 64% and DCR was 94% across all regimens. Subgroup analyses stratified by PD-1 inhibitor type revealed significant differences: toripalimab-based regimens achieved the highest ORR and longest median PFS of 21.4 months, while tislelizumab plus chemotherapy yielded the most favorable median OS of 45.3 months. Camrelizumab plus chemotherapy showed a median OS of 34.5 months. Subgroup analysis by study design (randomized controlled trials vs. non-randomized single-arm studies) confirmed highly consistent outcomes, supporting the robustness of pooled estimates. The pooled incidence of grade ≥3 TRAEs was 13%, with comparable safety profiles across all PD-1 inhibitors and no unexpected safety signals. Conclusions: PD-1 inhibitors combined with chemotherapy provide robust efficacy and durable long-term survival benefits in RM-NPC. Toripalimab, tislelizumab, and camrelizumab demonstrate superior therapeutic effects compared with other agents, with toripalimab showing optimal tumor response and PFS, and tislelizumab offering the best long-term OS. The findings support individualized PD-1 inhibitor selection in clinical practice and confirm the reliability of single-arm meta-analyses combining randomized and non-randomized evidence for agent-stratified comparison. Systematic Review Registration: https://www.crd.york.ac.uk/prospero/, identifier CRD420261361323.
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