ASCO 2025 | Sequencing IO and radiotherapy in nasopharyngeal carcinoma
Jun Ma, MD, Sun Yat-sen University Cancer Center, Guangzhou, China, comments on the potential benefits of integrating PD-1 immunotherapy (IO) with chemo-radiotherapy in the treatment of nasopharyngeal carcinoma (NPC). Utilizing anti-PD-1-agents throughout the treatment course or in the adjuvant phase alone can improve survival in patients with NPC, and combining PD-1 blockades with chemotherapy and radiotherapy may enhance cytotoxic T-cell activity and anti-tumor responses. This This interview took place during the 2025 American Society of Clinical Oncology (ASCO) Meeting in Chicago, IL.
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Transcript
PD-1 blockades have been integrated with the definitive chemo radiotherapy in various ways across the full traditional course induction, concurrent and adjuvant phase. In induction plus adjuvant phase, concurrent plus adjuvant phase, or in a single phase alone. Based on the continued and deep studies, the use of the PD-1 blockades throughout the four courses or in the adjuvant phase alone improved three years even free survival by 10% in NPC...
PD-1 blockades have been integrated with the definitive chemo radiotherapy in various ways across the full traditional course induction, concurrent and adjuvant phase. In induction plus adjuvant phase, concurrent plus adjuvant phase, or in a single phase alone. Based on the continued and deep studies, the use of the PD-1 blockades throughout the four courses or in the adjuvant phase alone improved three years even free survival by 10% in NPC. Preclinical research has also shown that comparing PD-1 blockades with gemcitabine, suspending chemoradiotherapy enhances the cytotoxic T-cell activity and the anti-tumor responses, supporting its use in induction and adjuvant phases. And radiotherapy to lymphatic drainage areas may depend on the immune responses. So one particularly promising strategy is PD-1 blockades administered during the induction and adjuvant phase, but not during the radiotherapy. The Phase III BEACON Study demonstrated that the adding tislelizumab during the induction and adjuvant phases significantly improved the post-induction complete response rates, compared to the chemo radiotherapy alone. Our team is now conducting a multi-center fixed-free randomized trial of cadonilimab antibody, a PD-1 and CTLA-4 bispecific antibody combined with induction chemotherapy followed by concurrent radiotherapy and adjuvant therapy with the cadonilimab antibody. In locally region advanced NPC, results are expected in 2027 and will offer a more definitive answer on the optimal sequencing. As for the duration, most current trials use immunotherapy for 9 to 12 months, with the adjuvant phase lasting 6 to 12 months. As strategies shift toward induction plus the adjuvant approaches, and oral agents like the capecitabine are introduced. Further, studies may reduce total immunotherapy duration to approximately about 6 months, about eight cycles given every three weeks, while also exploring a risk updated approach based on EBV DNA levels, in which lower risk patients receive only six months of PD-1 pro case. We hope this research helps refine the treatment duration and improve the patient outcomes.
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Disclosures
Research Funding – Bristol Myers Squibb Foundation; Varian Medical Systems
