One-Two Punch: Combining Chemotherapy and Immunotherapy to Decrease Radiation Dose and Related Toxicity in Children and Adolescents with Nasopharyngeal Carcinoma

Nasopharyngeal carcinoma is rare in children and adolescents. Although radiation has been an essential component of treatment for this often-curable tumor, it can lead to severe side effects in survivors. Therefore, the reduction of radiation-related long-term effects by limiting radiation dose is a key clinical priority. Previous pediatric clinical trials by the Children's Oncology Group and the German Society of Pediatric Oncology and Hematology have treated patients with induction chemotherapy followed by radiation with concomitant chemotherapy and adjuvant immunotherapy with IFN, leading to excellent survival. These groups now take us forward into a new age of clinical trials using chemotherapy-immunotherapy induction with anti-PD-1 therapies followed by response-adapted, dose-reduced radiation with the goal of preserving outcomes while limiting late effects and morbidities.