PD-1 inhibitors plus chemotherapy achieve 64% objective response rate in recurrent or metastatic nasopharyngeal carcinomaDifferent PD-1 Inhibitors Show Varying Results for Nasopharyngeal Cancer

BackgroundRecurrent or metastatic nasopharyngeal carcinoma (RM−NPC) is associated with poor prognosis. PD−1 inhibitors combined with chemotherapy have become the standard first−line treatment, but the comparative efficacy, long−term survival, and safety of different PD−1 inhibitors remain unclear. This study aimed to evaluate the impact of distinct PD−1 inhibitors plus chemotherapy for RM−NPC.MethodsWe conducted a systematic review and single−arm meta−analysis including 19 studies with 1459 patients. Outcomes included objective response rate (ORR), disease control rate (DCR), progression−free survival (PFS), overall survival (OS), and grade ≥3 treatment−related adverse events (TRAEs). Pooled analyses and subgroup comparisons stratified by PD−1 inhibitor type were performed.ResultsThe pooled ORR was 64% and DCR was 94% across all regimens. Subgroup analyses stratified by PD−1 inhibitor type revealed significant differences: toripalimab−based regimens achieved the highest ORR and longest median PFS of 21.4 months, while tislelizumab plus chemotherapy yielded the most favorable median OS of 45.3 months. Camrelizumab plus chemotherapy showed a median OS of 34.5 months. Subgroup analysis by study design (randomized controlled trials vs. non−randomized single−arm studies) confirmed highly consistent outcomes, supporting the robustness of pooled estimates. The pooled incidence of grade ≥3 TRAEs was 13%, with comparable safety profiles across all PD−1 inhibitors and no unexpected safety signals.ConclusionsPD−1 inhibitors combined with chemotherapy provide robust efficacy and durable long−term survival benefits in RM−NPC. Toripalimab, tislelizumab, and camrelizumab demonstrate superior therapeutic effects compared with other agents, with toripalimab showing optimal tumor response and PFS, and tislelizumab offering the best long−term OS. The findings support individualized PD−1 inhibitor selection in clinical practice and confirm the reliability of single−arm meta−analyses combining randomized and non−randomized evidence for agent−stratified comparison.Systematic Review Registrationhttps://www.crd.york.ac.uk/prospero/, identifier CRD420261361323.