Efficacy and safety of induction chemoimmunotherapy versus induction chemotherapy in patients with locoregionally advanced nasopharyngeal carcinoma: A meta-analysis.

Abstract

e18073 Background: Induction chemotherapy followed by concurrent chemoradiotherapy is the standard treatment for locally advanced nasopharyngeal carcinoma (LA-NPC), but one-fourth of patients still experience a poor prognosis. In recent years, several clinical trials have explored the application of induction chemoimmunotherapy followed by concurrent chemoradiotherapy in patients with LA-NPC, but its exact efficacy and safety remain incompletely understood. This meta-analysis aims to systematically integrate the existing evidence and comprehensively evaluate the efficacy and safety of comparing induction chemoimmunotherapy with standard induction chemotherapy in patients with LA-NPC, thereby providing a more robust basis for clinical decision-making. Methods: The protocol was registered in the Prospective Register of Systematic Reviews (PROSPERO, CRD42024619387). A comprehensive search was performed in several electronic databases, including PubMed, Embase, and the Cochrane Library, covering the period from their inception to December 31, 2024, to identify eligible clinical trials comparing the efficacy and safety of induction chemoimmunotherapy and induction chemotherapy in LA-NPC. Conference proceedings and reference lists of relevant articles were also manually searched to identify additional studies. The primary outcome measures were objective response rate (ORR), complete response rate (CRR), and the incidence of treatment-related adverse events (TRAEs). Meta-analysis was performed using Cochrane Collaboration Review Manager 5.4.1 and Meta-Analyst Beta 3.13 statistical software. Results: A total of seven clinical trials, comprising two randomized controlled trials and five retrospective trials, were rated as high-quality and included in this meta-analysis. These studies involved 1,680 patients diagnosed with LA-NPC. The meta-analysis showed that the induction chemoimmunotherapy group had significantly better ORR (odds ratio[OR]=2.03, 95% credible intervals [CI]:1.44-2.86), and CRR (OR=2.61, 95%CI:1.55-4.38) than the induction chemotherapy group. The pooled ORR and CCR of induction chemoimmunotherapy were 92.7% (95%CI:90.7-94.7%) and 24.3% (95%CI:15.2-33.6%), respectively. There was no significant difference of TRAEs between induction chemotherapy group and induction chemoimmunotherapy group (OR=1.11; 95%CI:0.90-1.37). In the one-arm meta-analysis, the rate of immune-related adverse events was 8.3% (95%CI:4.1-12.5%) during induction therapy. Conclusions: Induction chemoimmunotherapy demonstrates significant advantages in terms of ORR and CCR with an acceptable safety profile. It is still worthwhile to further investigate whether the improvements in ORR and CRR can be translated into long-term survival benefits.