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299

ICAR SINONASAL TUMORS

TABLE XXV.9 Evidence surrounding treatment of metastatic NPC.

Clinical endpoints

Study

Year LOE Study design Study groups

Conclusions

1. CRT group had significantly improved OS and PFS compared with chemotherapy alone group 2. CRT group had significantly improved ORR and DCR compared with chemotherapy alone group 1. In recurrent/metastatic NPC patients treated with anti-PD-1 therapy, the pooled ORR was 27%, DCR was 63%, 6-month PFS rate was 49%, 1-year PFS rate was 25%, and 1-year OS rate was 61% 2. Pooled incidence of any grade of AEs was 94% and grade 3–5 AEs was 20% 1. Triplet combination regimen demonstrated the best short-term efficacy with a highest ORR, DCR, and 6-month PFS rate, while 1-year OS rate was little lower than TP regimen 2. TP regimen showed a highest 1-year OS rate and good short-term efficacy with ORR of 0.6 and a DCR of 0.92, comparable with triplet combination therapy 3. Efficacy of GP regimen fell between FP and TP regimens 4. FP regimen had the lowest ORR and 1-year OS rate 1. Use of combination therapy in the first-line setting had a statistically significant PFS improvement over single agent, yet combination therapy regimen was more likely to report grade 3–4 hematological toxicities 2. Platinum-containing regimen in the first-line setting had improved PFS and improved ORR, yet with more occurrence of grade 3–4 hematological toxicities 3. Molecularly targeted agents (include pazopanib, gefitinib, and cetuximab ± carboplatin) had lower median OS than that estimated from all studies No significant differences between pembrolizumab and chemotherapy groups in OS, median PFS, ORR, median DOC, and OS in either ITT or in patients with PD-L1 CPS ≥ 1

1. OS 2. PFS 3. ORR,DCR

Wangand Shen 1705

2021 1

Meta-analysis 3402 metastatic NPC patients from 16 studies CRTversus chemotherapy alone

Wanget al. 1706

2020 1

Systemic

452 patients with

1. ORR,DCR 2. PFS,OS 3. Drug-related AEs

reviewand meta analysis

recurrent/metastatic NPC treated with anti PD-1/PD-L1 alone, from eight studies 973 patients with recurrent/metastatic NPCfrom16 studiesFour arms - FP: 5-FU + platinum - GP: gemc itabine + platinum - TP: taxanes + platinum - Triplet combination regimen 2267 patients from 56 studies - Combination regimen versus single agent regimen in first-line setting - Platinum-based versus nonplatinum-based regimen in first-line setting - Molecularly targeted agents

Maet al. 1701

1. ORR 2. DCR,

2018 1

Systemic

reviewand meta analysis

6-month PFS, and 1-year OS

Prawira

2017 1

Systematic review

1. PFS,OS 2. ORR

et al. 1700

Chanet al. 1710

1. OS 2. PFS, OS, DoR

233 patients with

2021 2

Multicenter,

platinum pretreated EBV-positive recurrent/metastatic NPC of WHO types II/III, then treated with

open-label, randomized phase III study

pembrolizumab versus standard chemotherapy

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