Abstract
OBJECTIVES: The decision on trade-off between the chance of salvage and the risk of serious toxicity in locally recurrent nasopharyngeal carcinoma (lrNPC) is a dilemma both to the clinician and patients. This study aimed to evaluate the efficacy of our watch-and-wait (W-W) strategy by receiving low-intensity maintenance treatment (LIMT) in lrNPC patients who achieved objective response after immune checkpoint inhibitors plus chemotherapy (ICI-chemotherapy), and explore the possibility of sparing or delaying local treatment. METHODS: LrNPC patients who were treated in our institution from January 2022 to May 2023 were candidates for this study. All enrolled patients would receive protocolized ICI-chemotherapy followed by LIMT alone (W-W approach) without immediate local treatment. The objective response rate (ORR), progression free survival (PFS), overall survival (OS) and safety profile were evaluated. RESULTS: Twenty-six lrNPC patients were included, 18 patients (69.2%) achieved objective response after ICI-chemotherapy, and continued with LIMT, 17 of them (17/18, 94.4%) maintained a state of disease remission without requiring local treatment, only one patient experienced PD during LIMT. Six patients remained in SD at the completion of ICI-chemotherapy, two patients experienced PD during ICI-chemotherapy. The 2-year OS and PFS were 87.8% and 64.0%, respectively. Reported adverse events were all manageable and no severe treatment-emergent adverse event were detected. CONCLUSIONS: For patients achieving response after ICI-chemotherapy, a “W-W” approach by continuing with LIMT, eschewing immediate local therapy, may be a viable option. Well-designed, prospective trials with conventional approaches involving earlier local treatment in comparison are essential to confirm the benefit of this innovative approach.