Adjuvant Camrelizumab in Locally Advanced Nasopharyngeal Carcinoma

Most nasopharyngeal carcinomas (NPCs) express PD-L1, making them excellent targets for PD-1 immunotherapy. In a recent phase 3, randomized trial (CONTINUUM), researchers found that adding the anti–PD-1 antibody sintilimab to induction and concurrent therapies in patients with locally advanced NPC led to significant improvements in event-free survival (EFS; Lancet 2024; 403:2720). Now, investigators report on the anti–PD-1 antibody camrelizumab as adjuvant therapy for locoregionally advanced NPC.

In this phase 3, open-label, multicenter trial in China (DIPPER), 450 patients with locoregionally advanced NPC who had already completed induction chemotherapy and definitive chemoradiation were randomized to adjuvant camrelizumab intravenously every 3 weeks for 12 cycles or standard observation. In the primary endpoint analysis, adjuvant camrelizumab significantly improved 3-year EFS compared with observation (86.9% vs. 77.3%; hazard ratio, 0.56). It was also associated with significantly reduced risks of distant metastasis (HR, 0.54) and locoregional relapse (HR, 0.53). Overall survival was similar between the groups at 3 years (96.4% and 92.9%). Reactive capillary endothelial proliferation was the most common adverse event, occurring in 85.8% of patients, but was mostly mild. Grade 3 or 4 adverse events were more common with camrelizumab than with observation (11.2% vs. 3.2%); no significant deterioration in health-related quality of life was observed.