This paper retrospectively analyzed the diagnosis and treatment process of a patient with advanced nasopharyngeal carcinoma (NPC) accompanied by multiple liver, lung, and lymph node metastases. The patient underwent camrelizumab immunotherapy in conjunction with chemotherapy, and demonstrated positive efficacy with a progression-free survival of 55 months. Despite a 5-month interruption in immunotherapy treatment caused by the COVID-19 epidemic, the patient's tumor remained well controlled with no apparent signs of recurrence or metastasis. Throughout the treatment, there were no grade 3-4 treatment-related side effects, and the patient's quality of life remained good. Immunotherapy combined with chemotherapy can bring significant survival benefits to patients with the recurrent/metastatic NPC.
1.Sung H, Ferlay J, Siegel RL, et al. Global Cancer Statistics 2020: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries[J]. CA Cancer J Clin, 2021, 71(3): 209-249. DOI: 10.3322/caac.21660.
2.Wu F, Wang R, Lu H, et al. Concurrent chemoradiotherapy in locoregionally advanced nasopharyngeal carcinoma: treatment outcomes of a prospective, multicentric clinical study[J]. Radiother Oncol, 2014, 112(1): 106-111. DOI: 10.1016/j.radonc.2014.05.005.
3.Jia GD, Sun XS, Li XY, et al. Clinical characteristics and prognostic factors affecting survival after radical radiotherapy for early and late post-treatment metastatic nasopharyngeal carcinoma[J]. BMC Cancer, 2023, 23(1): 7. DOI: 10.1186/s12885-022-10494-7.
4.Tang LL, Chen YP, Chen CB, et al. The Chinese Society of Clinical Oncology (CSCO) clinical guidelines for the diagnosis and treatment of nasopharyngeal carcinoma[J]. Cancer Commun (Lond), 2021, 41(11): 1195-1227. DOI: 10.1002/cac2.12218.
5.Eisenhauer EA, Therasse P, Bogaerts J, et al. New response evaluation criteria in solid tumours: revised RECIST guideline (version 1.1)[J]. Eur J Cancer, 2009, 45(2): 228-247. DOI: 10.1016/j.ejca.2008.10.026.
6.Teo PM, Kwan WH, Lee WY, et al. Prognosticators determining survival subsequent to distant metastasis from nasopharyngeal carcinoma[J]. Cancer, 1996, 77(12): 2423-2431. DOI: 10.1002/(SICI)1097-0142(19960615)77:12< 2423::AID-CNCR2>3.0.CO;2-N.
7.Lu TZ, Zeng FJ, Hu YJ, et al. Anatomic prognostic factors and their potential roles in refining M1 classification for de novo metastatic nasopharyngeal carcinoma[J]. Cancer Med, 2023, 12(24): 22091-22102. DOI: 10.1002/cam4.6816.
8.Prawira A, Oosting SF, Chen TW, et al. Systemic therapies for recurrent or metastatic nasopharyngeal carcinoma: a systematic review[J]. Br J Cancer, 2017, 117(12): 1743-1752. DOI: 10.1038/bjc.2017.357.
9.Fang W, Yang Y, Ma Y, et al. Camrelizumab (SHR-1210) alone or in combination with gemcitabine plus cisplatin for nasopharyngeal carcinoma: results from two single-arm, phase 1 trials[J]. Lancet Oncol, 2018, 19(10): 1338-1350. DOI: 10.1016/s1470-2045(18)30495-9.
10.Xu JY, Wei XL, Wang YQ, et al. Current status and advances of immunotherapy in nasopharyngeal carcinoma[J/ OL]. Ther Adv Med Oncol, 2022, 14: 17588359221096214. DOI: 10.1177/ 17588359221096214.
11.Fang W, Zhang J, Hong S, et al. EBV-driven LMP1 and IFN-γ up-regulate PD-L1 in nasopharyngeal carcinoma: implications for oncotargeted therapy[J]. Oncotarget, 2014, 5(23): 12189-12202. DOI: 10.18632/oncotarget.2608.
12.Silva JM, Alves CEC ,Pontes GS. Epstein-Barr virus: the mastermind of immune chaos[J]. Front Immunol, 2024, 15: 1297994. DOI: 10.3389/fimmu.2024.1297994.
13.Wang J, Ge J, Wang Y, et al. EBV miRNAs BART11 and BART17-3p promote immune escape through the enhancer-mediated transcription of PD-L1[J]. Nat Commun, 2022, 13(1): 866. DOI: 10.1038/s41467-022-28479-2.
14.Chen YP, Chan ATC, Le QT, et al. Nasopharyngeal carcinoma[J]. Lancet, 2019, 394(10192): 64-80. DOI: 10.1016/s0140-6736(19)30956-0.
15.Grasselly C, Denis M, Bourguignon A, et al. The antitumor activity of combinations of cytotoxic chemotherapy and immune checkpoint inhibitors is model-dependent[J]. Front Immunol, 2018, 9: 2100. DOI: 10.3389/fimmu.2018. 02100.
16.Principe DR, Kamath SD, Korc M, et al. The immune modifying effects of chemotherapy and advances in chemo-immunotherapy[J]. Pharmacol Ther, 2022, 236: 108111. DOI: 10.1016/j.pharmthera.2022.108111.
17.Fournel L, Wu Z, Stadler N, et al. Cisplatin increases PD-L1 expression and optimizes immune check-point blockade in non-small cell lung cancer[J]. Cancer Lett, 2019, 464: 5-14. DOI: 10.1016/j.canlet.2019.08.005.
18.Ng HY, Li J, Tao L, et al. Chemotherapeutic treatments increase PD-L1 expression in esophageal squamous cell carcinoma through EGFR/ERK activation[J]. Transl Oncol, 2018, 11(6): 1323-1333. DOI: 10.1016/j.tranon.2018.08.005.
19.Tran L, Allen CT, Xiao R, et al. Cisplatin alters antitumor immunity and synergizes with PD-1/PD-L1 inhibition in head and neck squamous cell carcinoma[J]. Cancer Immunol Res, 2017, 5(12): 1141-1151. DOI: 10.1158/2326-6066.Cir-17-0235.
20.van der Most RG, Currie AJ, Mahendran S, et al. Tumor eradication after cyclophosphamide depends on concurrent depletion of regulatory T cells: a role for cycling TNFR2-expressing effector-suppressor T cells in limiting effective chemotherapy[J]. Cancer Immunol Immunother, 2009, 58(8): 1219-1228. DOI: 10.1007/s00262-008-0628-9.
21.Yang Y, Qu S, Li J, et al. Camrelizumab versus placebo in combination with gemcitabine and cisplatin as first-line treatment for recurrent or metastatic nasopharyngeal carcinoma (CAPTAIN-1st): a multicentre, randomised, double-blind, phase 3 trial[J]. Lancet Oncol, 2021, 22(8): 1162-1174. DOI: 10.1016/s1470-2045(21)00302-8.
22.Yang Y, Pan J, Wang H, et al. Tislelizumab plus chemotherapy as first-line treatment for recurrent or metastatic nasopharyngeal cancer: a multicenter phase 3 trial (RATIONALE-309)[J]. Cancer Cell, 2023, 41(6): 1061-1072. DOI: 10.1016/j.ccell.2023.04.014.
23.Mai HQ, Chen QY, Chen D, et al. Toripalimab plus chemotherapy for recurrent or metastatic nasopharyngeal carcinoma: the JUPITER-02 randomized clinical trial[J]. JAMA, 2023, 330(20): 1961-1970. DOI: 10.1001/jama.2023.20181.
24.Manako T, Yasumatsu R, Nakano T, et al. Immune checkpoint inhibitors for nasopharyngeal carcinoma in a real-world setting in Japan[J]. In Vivo, 2023, 37(2): 747-755. DOI: 10.21873/invivo.13137.
25.Lim DW, Kao HF, Suteja L, et al. Clinical efficacy and biomarker analysis of dual PD-1/CTLA-4 blockade in recurrent/metastatic EBV-associated nasopharyngeal carcinoma[J]. Nat Commun, 2023, 14(1): 2781. DOI: 10.1038/s41467-023-38407-7.