Addition of immune checkpoint inhibitor to standard of care chemoradiotherapy in patients with locally advanced nasopharyngeal carcinoma: a systematic review and meta-analysis
Abstract
Background: Preliminary findings from this study were previously published as a conference abstract (https://doi.org/10.1158/2326-6074.IO2025-B039). Immune checkpoint inhibitors (ICIs) have shown activity in nasopharyngeal carcinoma (NPC), but their efficacy and safety when integrated with standard chemoradiotherapy (CRT) for locally advanced NPC remain under investigation. We performed a systematic review and meta-analysis of randomized controlled trials evaluating the efficacy and safety of integrating ICIs with standard CRT-based treatment in patients with locally advanced NPC. Methods: MEDLINE and EMBASE were searched from inception through September 1, 2025, for English-language phase II or III randomized controlled trials evaluating ICIs plus standard therapy. Eligible studies reported efficacy outcomes, including progression-free/event-free survival (PFS/EFS), overall survival (OS), distant metastasis-free survival (DMFS), and locoregional recurrence-free survival (LRFS), and/or safety outcomes. Hazard ratios (HRs) were pooled using the generic inverse variance method, and risk ratios (RRs) for adverse events were pooled using the Mantel-Haenszel method. Fixed-effect models were used, with heterogeneity assessed using I2 statistics. Results: Three trials randomized 1,022 patients: CONTINUUM (n = 423), DIPPER (n = 450), and a phase II toripalimab trial (n = 149). The pooled safety population included 998 patients. ICIs significantly improved PFS/EFS [HR 0.54; 95%…
How strong is the evidence?
Evidence Hub reads this as a meta-analysis, done in people. Its evidence level is 1 of 5 (Highest · pooled evidence). Pooled evidence from several studies sits at the top of the evidence pyramid. Reported size: 1,022 participants or records.
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