Efficacy and Safety of PD-1/PD-L1 Inhibitors Combined With Anti-Angiogenic Tyrosine Kinase Inhibitors for Recurrent or Metastatic Nasopharyngeal Carcinoma: A Systematic Review and Single-Arm Meta-Analysis
In brief
Drug combinations produced tumor responses in 48% of recurrent nasopharyngeal cancer patients
Across nine studies and 357 patients, PD-1 or PD-L1 inhibitors combined with anti-angiogenic drugs produced responses in 48% and disease control in 83%. Severe treatment-related side effects occurred in 47%, including nasopharyngeal tissue death in 14%; response rates were higher in patients not previously treated with checkpoint inhibitors. Without randomized comparisons, the combinations' value versus standard treatments remains unclear.
- Journal
- Cancer medicine (Q1)
- Published
- 1 October 2026
- Study design
- Systematic review / meta-analysis of RCTs
- Evidence level
- Level 1, High (CEBM 1a)
- Authors
- Rongyi Hu, Tiebin Li, Ziman Luo, Huining Chen, Song Qu
- PMID
- 42811914
- DOI
- 10.1002/cam4.72340
Why clinicians should know about it
- Picked for Pharmacology (medical) (top studies of the week, 4 October 2026): High-quality evidence in a top journal
- Picked for Oncology and Radiation Oncology (top studies of the week, 4 October 2026): PD‑1/PD‑L1 + anti‑angiogenic TKIs in recurrent/metastatic NPC
- Picked for Epidemiology (top studies of the week, 4 October 2026): Systematic review of PD‑1 trials, not observational study
- Picked for Radiology, Radiation Oncology, Nuclear Medicine, Medical Physics and Imaging (top studies of the week, 4 October 2026): High-quality evidence in a top journal
Abstract
OBJECTIVE: To evaluate the efficacy and safety of PD-1/PD-L1 inhibitors plus small-molecule anti-angiogenic drugs (apatinib, anlotinib and famitinib) for recurrent/metastatic nasopharyngeal carcinoma (R/M NPC). METHODS: Systematic searches of major databases up to January 7, 2026 identified prospective single-arm Phase II trials and retrospective cohort/real-world studies of PD-1/PD-L1 inhibitors combined with apatinib, anlotinib, or famitinib in R/M NPC. Pooled response and safety rates were estimated using random-effects models, with study quality assessed by appropriate tools. RESULTS: Nine studies comprising 10 independent cohorts (357 patients) were included. The pooled objective response rate (ORR) was 48% (95% CI: 39%-57%), the disease control rate (DCR) 83% (95% CI: 77%-88%), and the 1-year overall survival rate 79% (95% CI: 68%-86%). The incidence of grade ≥ 3 treatment-related adverse events (TRAEs) was 47% (95% CI: 37%-58%). The most frequent serious TRAEs were hypertension (9%), hand-foot syndrome (10%), and nasopharyngeal necrosis (14%), with the latter requiring close monitoring due to its potential for severe bleeding complications. No treatment-related deaths were reported across all included studies. Subgroup analysis showed no significant difference in ORR between camrelizumab and toripalimab; apatinib yielded higher ORR than anlotinib; immunotherapy-naive patients had significantly higher ORR than those previously treated with immune checkpoint inhibitors (ICIs) (p = 0.0028). CONCLUSION: The combination shows promising antitumor activity and a generally acceptable safety profile in R/M NPC, particularly for immunotherapy-naive patients. These findings support further investigation in well-designed randomized controlled trials, but confirmation of its role relative to standard therapies requires larger comparative studies.
Abstract as published, via PubMed.
For healthcare professionals. The summary is generated by AI from the published abstract, and the evidence level is assigned automatically from the study design on the Oxford CEBM hierarchy. Neither is medical advice. Read the full paper before changing practice.