Immunotherapy in the First‐Line Treatment of Advanced Nasopharyngeal Carcinoma: A Systematic Review and Meta‐Analysis

Objectives Data regarding the clinical benefits of immune checkpoint inhibitors (ICIs) are limited in nasopharyngeal carcinoma (NPC). Therefore, we conducted a meta‐analysis of phase‐III clinical trials to evaluate the benefit of adding ICIs to chemotherapy in the first‐line treatment of advanced NPC. Methods We conducted a systematic review using Web of Science, PubMed, and Embase for studies published until September 21, 2022. The meta‐analyses were performed with the generic inverse‐variance method with a random‐effects model. Hazard ratios (HRs) with 95% confidence interval (CI) for progression‐free survival (PFS) and overall survival (OS) were the principal summary measures. This protocol was registered in the PROSPERO database (registration number: CRD 42022361866). Results Three eligible studies with a total of 815 patients were included. The addition of ICIs to standard chemotherapy significantly improved PFS (HR: 0.52, 95% CI: 0.43–0.63, p < 0.0001). Although the OS results were immature, ICIs significantly reduced the risk of death (HR: 0.63, 95% CI: 0.47–0.84, p = 0.0020). The benefit of ICIs was consistent regardless of initial disease presentation (recurrent or de novo), baseline EBV levels, PD‐L1 expression, and ECOG performance status. No significant difference in the rates of serious adverse events (HR = 0.98, 95% CI 0.74–1.30) was found between the two groups. Conclusion The available evidence demonstrates that adding ICIs to chemotherapy in the first‐line treatment of advanced NPC provided better PFS with acceptable safety. However, a longer follow‐up is required to evaluate the true OS benefit of these combinations. Level of Evidence NA Laryngoscope , 134:7–17, 2024