From Evidence to Practice: Integrating Toripalimab into Frontline Care for Recurrent Locally Advanced or Metastatic Nasopharyngeal Carcinoma

Panelists discuss the distinct Epstein-Barr virus (EBV)-driven biology of nasopharyngeal carcinoma (NPC), the role of plasma EBV DNA as a biomarker, and the strong evidence supporting gemcitabine-based induction chemotherapy followed by chemoradiotherapy as standard treatment for locally advanced disease.

Panelists discuss the standard management of recurrent/metastatic nasopharyngeal carcinoma (NPC), emphasizing surgery or re-irradiation when feasible, and gemcitabine-cisplatin chemotherapy as the systemic backbone, while highlighting the need for more effective therapies to improve long-term outcomes.

Panelists discuss the biological rationale and consistent clinical data supporting PD-1 checkpoint inhibitors—such as toripalimab, nivolumab, and pembrolizumab—as active and meaningful treatments in recurrent/metastatic nasopharyngeal carcinoma (R/M NPC), particularly given the Epstein-Barr virus (EBV)-driven, immune-infiltrated nature of the disease.

Panelists discuss the phase 3 JUPITER-02 trial, which showed that adding PD-1 blockade to chemotherapy significantly improved progression-free survival in recurrent/metastatic (R/M) Epstein-Barr virus (EBV)-positive nasopharyngeal carcinoma (NPC), with biomarker analyses suggesting greater benefit in patients with high EBV DNA levels and PD-L1 expression.

Panelists discuss the 4-year JUPITER-02 data confirming that adding PD-1 inhibitors to chemotherapy significantly improves long-term survival with manageable safety in recurrent/metastatic nasopharyngeal carcinoma (R/M NPC), supporting this combination as the new standard of care and highlighting strategies for local consolidation in limited metastatic disease.

Panelists discuss the critical role of patient education and vigilant monitoring to manage immune-related toxicities during treatment, emphasizing the challenges of distinguishing the adverse effects from chemotherapy from immunotherapy, strategies for safely adjusting therapies, and the continued importance of radiation in select cases to enhance outcomes.

Panelists discuss the efficacy of multiple PD-1 inhibitors studied in nasopharyngeal cancer (NPC), noting similar overall outcomes despite differences in trial designs and adverse effect profiles, challenges in direct comparisons due to crossover and varying chemotherapy backbones, and how limited US approvals impact clinical choice—yet collectively these data affirm the integral role of PD-1 blockade as a cornerstone of treatment.

Panelists discuss the cautious use of PD-1 inhibitors in recurrent/metastatic nasopharyngeal carcinoma patients with preexisting autoimmune diseases or organ transplants due to high risks of severe toxicity and graft rejection, emphasizing individualized treatment decisions based on disease burden, symptoms, and patient frailty to balance efficacy and safety.

Panelists discuss how PD-1 inhibitors combined with chemotherapy have become the standard for recurrent nasopharyngeal carcinoma (NPC), the importance and challenges of using Epstein-Barr virus (EBV) as a biomarker, emerging therapies such as vaccines and CAR T cells, and the need for novel treatments as more patients receive up-front immunotherapy.