Prof. Ye Guo: A breakthrough in immunotherapy for recurrent and metastatic nasopharyngeal carcinoma

Tumor immunotherapy is in a stage of rapid development, and innovative trials are in full swing
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In this context, in order to focus on immunotherapy innovation, the 2021 CSCO 4th National Tumor Immunotherapy Summit Forum will be officially held in Jinan on May 28-30
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The big cancer experts from all over the country gathered together to participate in the grand event
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Yimaitong is fortunate to invite Professor Guo Ye from Dongfang Hospital of Tongji University to share on the progress of immunotherapy for recurrent/metastatic nasopharyngeal carcinoma
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Expert profileProfessor Guo YeDeputy Director of the Department of Oncology and Director of the Phase I Clinical Center of the Oriental Hospital Affiliated to Tongji University Deputy Secretary-General of the Chinese Society of Clinical Oncology Chairman of the Head and Neck Oncology Expert Committee of the Chinese Society of Clinical Oncology Member of the Standing Committee of the Lymphoma Alliance of the Chinese Society of Clinical Oncology Thyroid of the Chinese Society of Clinical Oncology Vice Chairman of the Cancer Expert Committee Vice Chairman of the Head and Neck Tumor Professional Committee of the Chinese Medical Doctor Association Vice Chairman of the Head and Neck Tumor Professional Committee of the Chinese Medical Doctor Association Vice Chairman of the Youth Committee of the Cancer Chemotherapy Professional Committee of the Chinese Anti-Cancer Association Member of the Head and Neck Tumor Professional Committee of the Chinese Anti-Cancer Association China Member of the Nasopharyngeal Carcinoma Professional Committee of the Anti-Cancer Association Member of the Lymphoma Professional Committee of the Chinese Anti-Cancer Association Deputy Chairman of the Head and Neck Tumor Professional Committee of the Shanghai Anti-Cancer Association Deputy Chairman of the Head and Neck Tumor Professional Committee of the Shanghai Anti-Cancer Association Yi Maitong: CSCO Guidelines Recurrence/ In the part of metastatic head and neck squamous cell carcinoma, pembrolizumab single-agent or combination chemotherapy is listed as a level 1 expert recommendation, but the nationally approved indication is the single-agent treatment of people with CPS ≥ 20.
How to understand the guidelines and get approved The difference between the certificate? Professor Guo Ye: The approval of the indications for pembrolizumab as a single agent and combined chemotherapy for the first-line treatment of recurrent/metastatic head and neck squamous cell carcinoma is mainly based on the KEYNOTE-048 study
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The results of the study show that for patients with CPS ≥ 1, pembrolizumab as a single agent is superior to traditional chemotherapy combined with targeted therapy, so the US FDA has approved the use of pembrolizumab as a single agent in patients with CPS ≥ 1.

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However, a subgroup analysis of Asian patients showed that it seems that patients with CPS ≥ 20 are the best benefit groups for pembrolizumab
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Since the KEYNOTE-048 study did not include Chinese patients, based on global overall population data and Asian subgroup analysis results, as well as pharmacoeconomics and other factors, the indication approved by the National Medical Products Administration (NMPA) is pembrolizumab as a single agent Treat people with CPS ≥ 20
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The CSCO 2021 Head and Neck Tumor Diagnosis and Treatment Guidelines list pembrolizumab as a single agent or combination chemotherapy as a level 1.
Expert recommendation is mainly based on the evidence level of evidence-based medicine and the results of registered clinical studies, so it may lead to approval for adaptation There is a certain difference between the certificate and the guideline recommendation, which is also a normal phenomenon widely existing in other tumor types
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Yimaitong: Recurrent/metastatic head and neck squamous cell carcinoma has entered the age of immunotherapy.
How to further expand the application of immunotherapy in head and neck squamous cell carcinoma? What is the progress of the combination of immunotherapy and targeted therapy? Prof.
Guo Ye: Regarding recurrent/metastatic head and neck squamous cell carcinoma, immune checkpoint inhibitors have been approved one after another whether they are first-line treatment or salvage treatment, and very significant progress has been made
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But from the KEYNOTE-048 study, we have also seen that patients with negative PD-L1 expression have relatively little benefit from immune single drugs
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Therefore, how to further expand the application of immunotherapy in recurrent/metastatic head and neck squamous cell carcinoma, especially for patients with low PD-L1 expression, is the direction we need to think about in the future
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At present, there are also many immunological combination therapies being explored, including dual immunotherapy with PD-1 inhibitors and CTLA-4 inhibitors, and we look forward to the announcement of relevant results
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In addition, the combination of PD-1 inhibitors and anti-EGFR monoclonal antibodies has shown a good synergistic effect, and it is possible to expand the benefiting population of immunotherapy.
The key clinical trials of teriprizumab and cetuximab are also being carried out in China.
Research
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Yimaitong: Chinese scholars are at the forefront of the world in the field of nasopharyngeal cancer.
At the ASCO meeting in 2021, a number of Chinese studies were selected for oral presentations, such as the JUPITER-02 study led by Professor Xu Ruihua and Cary led by Professor Zhang Li Lizumab combined with chemotherapy is the first-line treatment of metastatic or recurrent nasopharyngeal carcinoma.
Could you please introduce how these research results will change current clinical practice? Professor Guo Ye: At this year's ASCO annual meeting, Professor Xu Ruihua delivered a keynote speech at the plenary meeting and reported the results of the JUPITER-02 study to oncologists around the world
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This is the first clinical study led by Chinese oncologists to be selected as a speech in the Blockbuster Study (LBA) of the General Assembly since the official record of the ASCO annual meeting, and it also reflects the importance of the JUPITER-02 study
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Nasopharyngeal cancer is the most distinctive type of cancer in China.
The incidence of nasopharyngeal cancer in China accounts for about half of the new cases of nasopharyngeal cancer in the world.
Therefore, it is the duty of Chinese medical workers to find a suitable treatment plan for nasopharyngeal cancer
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Teriplizumab was approved in China in February 2021 for the third-line treatment of recurrent/metastatic nasopharyngeal carcinoma.
Therefore, it is of great significance to explore whether immunotherapy combined with standard treatment regimens can further improve the efficacy
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Based on the excellent clinical data of the JUPITER-02 study, NMPA has accepted the marketing application of teriprizumab combined with chemotherapy for the first-line treatment of advanced nasopharyngeal cancer patients who have not received systemic treatment for recurrent/metastatic nasopharyngeal carcinoma
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The CAPTAIN-1ST study led by Professor Zhang Li also gave an oral presentation at the 2021 ASCO annual meeting.
Based on the excellent results of the study, NMPA has recently approved carrelizumab combined with cisplatin and gemcitabine for local recurrence or First-line treatment for patients with metastatic nasopharyngeal carcinoma
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The results of these two studies have once again proved that for nasopharyngeal carcinoma, a chemotherapy-sensitive tumor, the combination of PD-1 monoclonal antibody on the basis of chemotherapy can further benefit
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Through the unremitting efforts of Chinese scholars to explore, these research results are expected to change the clinical practice of recurrent/metastatic nasopharyngeal carcinoma in China and the world, and bring more hope to nasopharyngeal carcinoma patients worldwide
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