Now is an exciting era of development in immunotherapy checkpoint inhibitors and their effect on the treatment of NPC. While the general prognosis of R/M disease is poor, immunotherapy offers some promise in a malignancy associated with EBV and characterized by a peritumoural immune infiltrate. Our study aims to review past and on-going clinical trials of monoclonal antibody therapies against the checkpoint inhibitors (e.g. PD1 and CTLA-4), in R/M NPC. All randomized and nonrandomized controlled trials involving immune checkpoint inhibitor interventions for treatment of NPC were included in the study. We utilized a validated "risk of bias" tool to assess study quality. Four separate Phase I-II trials report the potential of PD1 inhibitor treatment for patients with NPC. Within the observed groups, camrelizumab combined with chemotherapy achieved an objective response in 91% of patients as first-line treatment for metastatic NPC (PFS 68% at 1-year) but this was associated with a high rate of grade >3 adverse events (87%; CTCAE version 4.03). The remaining three studies focused on recurrent NPC disease in patients who had received at least one line of prior chemotherapy. Within this group, camrelizumab monotherapy achieved an objective response in 34% of patients (PFS 27% at 1-year; range across all three studies 20.5-34%). No NPC trial has yet reported on specific outcomes for non-PD1 checkpoint inhibitors but 11 on-going studies include alternative targets (e.g. PD-L1/CTLA-4) as combination or monotherapy treatments. In considering checkpoint immunotherapies for NPC, initial results show promise for anti-PD1 interventions. Further phase I-III trials are in progress to clarify clinical outcomes, fully determine safety profiles, and optimize drug combinations and administration schedules.

中文翻译：

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晚期鼻咽癌的免疫检查点抑制剂：是否已经超过化学放射时代？

现在是免疫治疗检查点抑制剂及其对NPC治疗的激动人心的发展时代。尽管R / M疾病的一般预后较差，但免疫治疗在与EBV相关的恶性肿瘤中具有一定的前景，其特征是肿瘤周围免疫浸润。我们的研究旨在回顾R / M NPC中针对检查点抑制剂（例如PD1和CTLA-4）的单克隆抗体疗法的过去和正在进行的临床试验。该研究包括所有涉及免疫检查点抑制剂干预治疗NPC的随机和非随机对照试验。我们利用经过验证的“偏倚风险”工具评估研究质量。四个单独的I-II期试验报告了PD1抑制剂治疗NPC的潜力。在观察到的人群中，卡雷珠单抗联合化学疗法作为转移性鼻咽癌的一线治疗在91％的患者中获得了客观缓解（一年中PFS为68％），但这与3级以上不良事件发生率高有关（87％； CTCAE版本） 4.03）。其余三项研究的重点是已接受至少一线既往化疗的患者的复发性鼻咽癌。在这一组中，卡雷珠单抗单药治疗在34％的患者中达到了客观缓解（一年中PFS为27％；在所有三项研究中范围均为20.5-34％）。尚未有NPC试验报道非PD1检查点抑制剂的具体结局，但11项正在进行的研究包括联合或单药治疗的替代靶标（例如PD-L1 / CTLA-4）。在考虑针对NPC的检查点免疫疗法时，初步结果显示了抗PD1干预的希望。