Abstract
Objective:
The objective of this review is to evaluate clinical data regarding use of toripalimab and penpulimab use in recurrent or metastatic nasopharyngeal carcinoma (RM-NPC) and to assess their impact on patient care.
Data sources:
A literature search of PubMed, Cochrane library, and clinicaltrials.gov was performed using toripalimab, Loqtorzi, JS001, penpulimab, and AK105.
Study selection and data extraction:
Inclusion was limited to English-language publications evaluating toripalimab and penpulimab for RM-NPC management.
Data synthesis:
Toripalimab and penpulimab are the first US Food and Drug Administration (FDA)-approved immune checkpoint inhibitors for RM-NPC. Both agents block the PD-1/PD-L1 interaction between tumor and T cells, enhancing anti-tumor immune responses. In the first-line setting, toripalimab plus chemotherapy achieved a median progression-free survival (PFS) of 21.4 months and overall response rate (ORR) of 78.8%. Penpulimab plus chemotherapy demonstrated a median PFS of 9.6 months and ORR of 68.1%. Toripalimab/chemotherapy was associated with an improved overall survival (hazard ratio [HR] = 0.63, P = .008); penpulimab/chemotherapy overall survival data were not yet mature. As monotherapies, ORRs were 20.5% for toripalimab and 28.0% for penpulimab. Common adverse effects include immune-related adverse effects such as hypothyroidism and rash.
Relevance to patient care and clinical practice in comparison to existing drugs:
These agents offer crucial new therapeutic options for RM-NPC, previously managed primarily with chemotherapy. The data supporting toripalimab use are currently more mature; however, penpulimab may offer an alternative for patients unable to tolerate cisplatin due being studied in combination with carboplatin.
Conclusion:
Toripalimab and penpulimab significantly improve outcomes in RM-NPC. Their use is anticipated to expand into additional settings and malignancies as research matures.
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