Latest studies and clinical investigations into aggressive cancer affecting the nasopharynx
Nasopharyngeal carcinoma (NPC), a rare form of head and neck cancer, is undergoing significant advancements in its treatment methods. Researchers are focusing on integrating immunotherapy, particularly PD-1 inhibitors, into earlier treatments and optimising chemotherapy combinations, while also exploring ways to reduce radiation toxicity.
Toripalimab, a PD-1 inhibitor, has been approved for treating NPC in 2023. A recent phase 3 randomized clinical trial, known as the DIAMOND trial, has shown high efficacy and lower toxicity in locoregionally advanced NPC when toripalimab is combined with chemotherapy and radiotherapy, without the use of concurrent cisplatin. This approach, which aims to reduce side effects such as vomiting, has been found to be non-inferior in terms of failure-free survival compared to standard cisplatin-containing regimens.
Immunotherapy is a major focus in NPC treatment, with PD-1/PD-L1 blockade combined with chemotherapy or radiotherapy being explored to enhance antitumor immunity. Maintenance therapies using agents like capecitabine in patients with residual disease are also being investigated, with the aim of improving outcomes after initial treatment.
Radiotherapy de-escalation trials are another area of interest. For instance, a single-arm phase 2 trial is evaluating the restriction of radiation to the primary tumor alone while omitting prophylactic neck irradiation for patients with early nodal involvement (N0-1) and certain tumor criteria. This approach aims to reduce radiation toxicity without compromising efficacy.
For metastatic and oligometastatic NPC, ongoing research is investigating the combination of immunotherapy with stereotactic body radiotherapy (SBRT) to improve control of metastatic sites while managing toxicity. Current treatment guidelines for metastatic NPC recommend induction chemotherapy followed by locoregional chemoradiation, with the addition of immunotherapy as a modern standard in some settings. The NCT04944914 phase III trial is evaluating immunotherapy plus SBRT to define better approaches for metastatic NPC management.
In summary, recent advances in NPC treatment emphasize the integration of immunotherapy (especially PD-1 inhibitors like toripalimab), chemotherapy combination optimization, and radiotherapy intensity modulation to balance efficacy with reduced toxicity. The pivotal trials from 2024–2025, including the DIAMOND trial, show these strategies are nearing or entering clinical practice evaluation stages.
[1] DIAMOND trial [2] NCT02549348 [3] NCT04278727 [4] NCT04944914
- The DIAMOND trial, a significant phase 3 randomized clinical study, has demonstrated high efficacy and lower toxicity in treating locoregionally advanced nasopharyngeal carcinoma (NPC) with toripalimab, a PD-1 inhibitor, combined with chemotherapy and radiotherapy.
- Current research is focusing on maintenance therapies using agents like capecitabine for patients with residual NPC disease, aiming to improve outcomes after initial treatment.
- Radiotherapy de-escalation trials, such as restricting radiation to the primary tumor alone while omitting prophylactic neck irradiation, are being explored to reduce radiation toxicity without compromising efficacy in NPC treatment.
- The NCT04944914 phase III trial is currently investigating the combination of immunotherapy with stereotactic body radiotherapy (SBRT) for metastatic NPC to improve control of metastatic sites while managing toxicity.
