Addition of immunotherapy to standard of care first-line regimen delays disease progression in advanced NPC

Priscilla Lynch presents a round-up of some of the most topical research presented at this year’s ASCO Annual Meeting

The addition of the immunotherapy agent toripalimab to standard first-line chemotherapy significantly delayed disease progression for patients with recurrent or metastatic nasopharyngeal carcinoma (NPC), according to the findings of a phase 3 international study, presented at the 2021 ASCO Annual Meeting.

Toripalimab is a checkpoint inhibitor that works by blocking programmed cell death protein 1 (PD-1) found on the surface of immune cells, allowing the immune system to continue working properly. JUPITER-02 is one of the first studies in NPC to positively integrate a PD-1-blocking immunotherapy with upfront chemotherapy. Pending approval, the combination stands to become the new standard of care and may represent a paradigm shift in the care of these patients, for whom there are currently few treatment options.

NPC represents a significant global health problem, and is particularly prevalent in east and southeast Asia, which accounted for more than 70 per cent of the approximate 129,000 new diagnoses worldwide in 2018. Platinum-based therapy is currently standard first-line treatment for recurrent or metastatic NPC. However, the duration of response is, on average, less than six months.

The JUPITER-02 trial demonstrated that the addition of the immunotherapy toripalimab to standard first-line chemotherapy lengthened the time to disease progression compared with placebo, with a median of 11.7 months versus. 8.0 months, respectively. At one year, 49 per cent of patients who received toripalimab had not experienced disease progression, compared to 28 per cent of those who received placebo.

Serious adverse events (AEs) grade 3 or greater were similar for both groups – 89.0 per cent for toripalimab versus 89.5 per cent for placebo, with discontinuation of treatment in 7.5 per cent of immunotherapy patients, compared to 4.9 per cent that took placebo. Fatal AEs were similar between the two arms, 2.7 per cent and 2.8 per cent, respectively.
Immune-related AEs were more common with toripalimab, 39.7 per cent, compared with placebo,18.9 per cent. Immune-related AEs grade 3 or greater were also more common with toripalimab (7.5 per cent) than with placebo
(0.7 per cent).

“Nasopharyngeal carcinoma is challenging as it is typically diagnosed in an advanced stage when current therapy options are extremely limited. The extended response in patients that received with toripalimab marks a significant advance for treatment of this disease,” said Dr Rui-hua Xu, Department of Medical Oncology, Sun Yat-sen University Cancer Centre, Guangzhou, China.

“Treatment advances for late-stage nasopharyngeal carcinoma have lagged behind those of other cancers. Findings from the JUPITER-02 study offer new hope for patients with advanced disease, changing how we care for them,” said ASCO Chief Medical Officer and Executive Vice President, Dr Julie R Gralow.