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CASE REPORT article

Front. Immunol.
Sec. Cancer Immunity and Immunotherapy
Volume 15 - 2024 | doi: 10.3389/fimmu.2024.1467355
This article is part of the Research Topic The Tumor Microenvironment and Immunotherapy for Head and Neck Tumors View all 14 articles

Immunotherapy combined with chemotherapy without locoregional radiotherapy in de novo metastatic nasopharyngeal carcinoma: two case reports and a literature review

Provisionally accepted
Caiyun Zhang Caiyun Zhang 1*Yingna Gao Yingna Gao 1Xiaoqiong Shi Xiaoqiong Shi 1Lin Zhao Lin Zhao 2Hui Yao Hui Yao 1Guoning Yu Guoning Yu 1Jianqiao He Jianqiao He 1Yi Ma Yi Ma 1Hongliang Zheng Hongliang Zheng 1Minhui Zhu Minhui Zhu 1
  • 1 Department of Otorhinolaryngology-Head and Neck Surgery, Changhai Hospital, Naval Medical University,, Shanghai, China
  • 2 Department of Health Management Center, Shanghai Eastern Hepatobiliary Surgery Hospital, Shanghai, China

The final, formatted version of the article will be published soon.

    Background There is no consensus regarding the optimal regimen for de novo metastatic nasopharyngeal carcinoma (dmNPC). Locoregional intensity modulated radiotherapy (LRRT) following palliative chemotherapy (PCT) has been shown to prolong the overall survival (OS) and improve the progression-free survival (PFS) of patients with dmNPC, compared with PCT alone. Recently, immunotherapy has made great progress in the treatment of recurrent or metastatic NPC (RM-NPC). However, whether dmNPC can be treated with immunochemotherapy alone (without LRRT) remains controversial. Case presentation We report two cases of dmNPC, with radiological examination showed NPC with multiple systemic lymph node metastases, multiple bone metastases, and liver metastases. Both patients were diagnosed with dmNPC and received pabolizumab in combination with six courses of platinum-based chemotherapy treatment. After complete remission (CR) was achieved, the patients were maintained on pabolizumab alone. No LRRT was used throughout the course of the disease. Results We achieved good efficacy in these two cases of dmNPC. Both patients exhibited survival benefits (PFS has reached 31 months since diagnosis), and no serious chemotherapy- or immune-related adverse reactions occurred. Treatment-related toxicity from radiotherapy was avoided, with no obvious symptoms of neck muscle fibrosis, throat mucosa dryness, ear congestion, or nasal congestion. Conclusion Our findings suggested that chemotherapy combined with a PD-1 inhibitor without LRRT, followed by sequential immunotherapy as maintenance, can achieve good results in some dmNPC patients. Further validation of our results may be required in large, high-quality prospective clinical studies.

    Keywords: Immunotherapy, chemotherapy, de novo metastatic nasopharyngeal carcinoma (dmNPC), Epstein-Barr virus ( EBV), Locoregional radiotherapy

    Received: 19 Jul 2024; Accepted: 16 Dec 2024.

    Copyright: © 2024 Zhang, Gao, Shi, Zhao, Yao, Yu, He, Ma, Zheng and Zhu. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

    * Correspondence: Caiyun Zhang, Department of Otorhinolaryngology-Head and Neck Surgery, Changhai Hospital, Naval Medical University,, Shanghai, China

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