Toripalimab and Penpulimab: Targeting PD-1 in Recurrent or Metastatic Nasopharyngeal Carcinoma

Objective: The objective of this review is to evaluate clinical data regarding use of toripalimab and penpulimab use in recurrent or metastatic nasopharyngeal carcinoma (RM-NPC) and to assess their impact on patient care. Data sources: A literature search of PubMed, Cochrane library, and clinicaltrials.gov was performed using toripalimab, Loqtorzi, JS001 , penpulimab , and AK105 . Study selection and data extraction: Inclusion was limited to English-language publications evaluating toripalimab and penpulimab for RM-NPC management. Data synthesis: Toripalimab and penpulimab are the first US Food and Drug Administration (FDA)-approved immune checkpoint inhibitors for RM-NPC. Both agents block the PD-1/PD-L1 interaction between tumor and T cells, enhancing anti-tumor immune responses. In the first-line setting, toripalimab plus chemotherapy achieved a median progression-free survival (PFS) of 21.4 months and overall response rate (ORR) of 78.8%. Penpulimab plus chemotherapy demonstrated a median PFS of 9.6 months and ORR of 68.1%. Toripalimab/chemotherapy was associated with an improved overall survival (hazard ratio [HR] = 0.63, P = .008); penpulimab/chemotherapy overall survival data were not yet mature. As monotherapies, ORRs were 20.5% for toripalimab and 28.0% for penpulimab. Common adverse effects include immune-related adverse effects such as hypothyroidism and rash. Relevance to patient care and clinical practice in comparison to existing drugs: These agents offer crucial new therapeutic options for RM-NPC, previously managed primarily with chemotherapy. The data supporting toripalimab use are currently more mature; however, penpulimab may offer an alternative for patients unable to tolerate cisplatin due being studied in combination with carboplatin. Conclusion: Toripalimab and penpulimab significantly improve outcomes in RM-NPC. Their use is anticipated to expand into additional settings and malignancies as research matures.