Induction chemotherapy plus PD-1 blockade and nimotuzumab for locoregionally advanced nasopharyngeal carcinoma: a propensity-matched retrospective study

OBJECTIVE: Despite standard induction chemotherapy (IC) followed by concurrent chemoradiotherapy (CCRT), locoregionally advanced nasopharyngeal carcinoma (LANPC) continues to relapse and metastasize at high rates. Recent advances suggest that integrating immunotherapy and target agents may improve outcomes. This study aimed to evaluate the short-term efficacy and safety of combining PD-1 inhibitor and nimotuzumab with induction chemotherapy in LANPC patients. METHODS: We retrospectively analyzed 197 patients with LANPC treated at our institution between January 2022 and December 2023. Patients received either induction chemotherapy (IC) alone or IC plus PD-1 inhibitor and nimotuzumab (ICIT), followed by CCRT. Propensity score matching yielded 90 IC and 45 ICIT patients for analysis. Efficacy, adverse events, and survival outcomes were evaluated after induction and full course. RESULTS: The median follow-up duration was 22.8 months. Induction best overall response was higher with ICIT than with IC alone (95.6% vs. 80.0%, P = .03), driven by a marked reduction in stable disease. Subgroup analysis showed pronounced benefit in males, patients with advanced N stage, and those with high epidermal growth factor receptor expression. The ICIT group showed a trend toward improved early tumor shrinkage, with no locoregional failures observed. Hematologic toxicities were similar between groups, while the ICIT group experienced higher rates of grade 3 mucositis and hepatic toxicity. CONCLUSIONS: Adding PD-1 inhibitor plus nimotuzumab to induction chemotherapy improved early tumor shrinkage while maintaining an acceptable safety profile. These encouraging early data reinforce the need for ongoing prospective trials to confirm long-term benefit and to refine patient selection.