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February 17, 2022

Maintenance Capecitabine in Recurrent or Metastatic Nasopharyngeal Carcinoma—Magic Bullet or Pandora’s Box?

Author Affiliations
  • 1Clinical Oncology Centre, The University of Hong Kong-Shenzhen Hospital, Shenzhen, China
  • 2Department of Clinical Oncology, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China
  • 3Division of Radiation Oncology, Department of Head and Neck and Thoracic Cancers, National Cancer Centre Singapore, Singapore
  • 4Division of Medical Sciences, National Cancer Centre Singapore, Singapore
  • 5Oncology Academic Programme, Duke-NUS Medical School, Singapore
JAMA Oncol. 2022;8(4):524-525. doi:10.1001/jamaoncol.2021.7365

The natural history of recurrent or metastatic nasopharyngeal carcinoma (R/M-NPC) is highly variable. Prognoses of patients with R/M-NPC are influenced by factors such as disease burden (oligometastatic [<3-5 lesions] vs polymetastatic), sites of involvement (lung and lymph nodes vs other visceral and skeletal involvement), and timing of distant metastatic recurrences (de novo vs metachronous). For patients who are fit for systemic therapy, gemcitabine-cisplatin (GP) doublet therapy is the current chemotherapy recommendation, achieving a progression-free survival (PFS) of 7.9 months and overall survival (OS) of 22.1 months.1 More recently, 2 large randomized clinical phase 3 trials—CAPTAIN-1st2 and JUPITER-023—reported that the addition of anti–programmed cell death-1 (anti-PD-1) antibodies (camrelizumab2 and toripalimab3) in combination with GP, followed by maintenance anti-PD-1 antibody treatment until disease progression or up to 2 years, was superior to GP alone (median PFS for combination therapy, 10.8 months2 and 11.7 months3).

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