Optimal maintenance therapy strategy for metastatic nasopharyngeal carcinoma: Insights from a cohort study in an endemic region.

• DOI: 10.1200/jco.2025.43.16_suppl.6041
• Publication Date: 2025-05-28T21:08:28Z
• Authors: Zhuoying Luo; Yue Xia; Yuping Zhao; Haoyang Huang; Ying Deng; Zejiang Zhan; Yingying Huang; Xun Cao; Xi Chen; Jiayu Zhou; Chixiong Liang; Liang-Ru Ke; Xuehua Wei; Jin-Ling Duan; Xing Lv; Hu Liang

6041 Background: Managing metastatic nasopharyngeal carcinoma (mNPC) remains challenging due to its high incidence and mortality rates. While maintenance therapy shows promising potential, the optimal strategy unclear. A prior ranking question is if combined of anti-PD-1 antibodies capecitabine an effective for mNPC patients who achieved disease control after first-line therapy. Methods: Eligible with following subsequently received were included at Sun Yat-sen University Cancer Center between 2018 2023. Progression-free survival overall analyzed using Kaplan–Meier method log-rank test. Cox proportional hazards model inverse probability treatment weighting analysis applied adjust confounders. Based on interaction effects, stratification was performed. sensitivity based E-value from weighted model. Results: This cohort study 300 receiving monotherapy (n=211), immunotherapy (n=94) or (n=117), their combination (n=89). 234 (78.0%) male, median age 45 years (interquartile range [IQR]: 36–54). At follow-up 37.8 months (IQR: 35.6–40.1), significantly improved progression-free (PFS) compared single-drug [median PFS: not reached vs 27.0 months; hazard ratio (HR): 0.569, 95% Confidence Interval (CI): 0.368-0.878, P = 0.011; E-value, 2.32], though no improvement in observed. Stratification revealed enhanced efficacy without local (HR: 0.411, CI: 0.266–0.748, 0.004) elevated pre-maintenance Epstein-Barr virus (EBV) DNA levels 0.312, 0.106–0.917, 0.034). No significant difference prognosis observed groups. Combination regimen obtained superior either alone. The safety profile similar Conclusions: Combined therapy, particularly premaintenance EBV those treatment.