Efficacy of Anti-PD1 Blockade in Treating Recurrent or Metastatic Nasopharyngeal Cancer: A Systematic Review and Meta-analysis

OBJECTIVES

Anti-PD1 antibody has emerged as a promising immunotherapeutic option in patients with recurrent and/or metastatic nasopharyngeal cancers (RM-NPC). We aim to summarise existing evidence on the use of anti-PD1 antibodies in the treatment of these patients and compare its effectiveness with standard-of-care palliative chemotherapy. Our secondary aim is to explore potential combination therapies with anti-PD1 antibodies.

MATERIALS AND METHODS

PubMed, Embase and Cochrane databases were systematically searched for studies comparing the efficacy of various anti-PD1 antibodies in the treatment of RM-NPC (either as first or second line treatment) from inception to 2 September 2022. Meta-analyses were performed to correlate the various anti-PD1 antibodies with primary endpoints including overall response rate disease control rate (DCR), progression free survival (PFS) and overall survival (OS).

RESULTS

Eighteen studies with 1,887 patients met the inclusion criteria. The use of anti-PD1 antibody monotherapy as second-line treatment of RM-NPC revealed an ORR of 23 % (95 % CI = 19 %-28 %) and DCR of 51 % (95 % CI = 42 %-60 %). The ORRs for first-line as well as a combination of first and second-line treatments were 21 % (95 % CI = 15 % - 30 %) and 22 % (95 % CI = 6 % - 56 %, I² = 75 %) respectively. The 12-month PFS and 12-month OS was also 27 % (95 % CI = 21 %-33 %) and 63 % (95 % CI = 53 %-72 %) respectively. ORR was much higher at 73 % (95 % CI = 32 %-94 %) when anti-PD1 antibodies were combined with Gemcitabine plus Cisplatin.

CONCLUSION

Anti-PD1 antibody demonstrate considerable activity in previously treated RM-NPC patients. Combining anti-PD1 antibodies with gemcitabine and cisplatin chemotherapy enhanced the efficacy of treatment.

Outcomes of examination under anaesthesia of post-nasal space and grommet insertion in adults presenting with otitis media with effusion

BACKGROUND

In adults, otitis media with effusion causes considerable morbidity and has poorly established outcomes. A small number of nasopharyngeal carcinoma patients present with isolated ear-related symptoms. The investigation of choice for these patients is a point of debate.

METHODS

A retrospective cohort study was conducted using a local database of adult patients who underwent examination under anaesthesia of the post-nasal space with grommet insertion for otitis media with effusion between January 2014 and January 2016.

RESULTS

Ninety-eight patients met the inclusion criteria. Follow-up duration ranged from 39 to 63 months. Complications of grommets were present in 36 out of 98 patients (36.73 per cent). The findings of examination under anaesthesia of the post-nasal space were documented as abnormal in three patients. No patient was diagnosed with nasopharyngeal carcinoma.

CONCLUSION

Grommets in adults with otitis media with effusion as the sole presenting feature carry a high complication rate, especially in those with previously inserted grommets. Examination under anaesthesia of the post-nasal space offers a low yield. A magnetic resonance imaging scan of the post-nasal space may be a more sensitive alternative.

Prodigiosin Inhibits Proliferation, Migration, and Invasion of Nasopharyngeal Cancer Cells

BACKGROUND/AIMS

Nasopharyngeal carcinoma remains a devastating and difficult disease to treat. This study explores the antineoplastic effect of prodigiosin on nasopharyngeal cancer cells.

METHODS

Human nasopharyngeal carcinoma CNE2 cells and human normal nasopharyngeal epithelial NP69 cells were obtained and treated with prodigiosin or fluorouracil (5-FU). Colony formation assay was performed to screen for the optimal experimental concentrations of prodigiosin and 5-FU, and MTT assay was used to examine cell proliferative ability. Flow cytometry was used to examine cell cycle distribution, the scratch test was employed to examine cell migration, and Transwell migration assay (Boyden chamber) was used to study cell invasion.

RESULTS

The optimal concentrations of prodigiosin and 5-FU for treatment were 4 mg/L and 0.35 mg/L, respectively. Both prodigiosin and 5-FU inhibited tumor cell proliferation. The percentage of cells in G0/G1 phase was higher and the percentage of cells in S phase was lower in the prodigiosin and 5-FU groups than in the untreated groups. Both prodigiosin and 5-FU inhibited tumor cell migration and tumor cell invasion.

CONCLUSIONS

Our results suggest that prodigiosin can inhibit proliferation, migration, and invasion of nasopharyngeal carcinoma cells.

Surgical management of nasal stenosis following chemoradiation for nasopharyngeal carcinoma

BACKGROUND

Nasal stenosis is a rare but significant complication of chemoradiation treatment for nasopharyngeal carcinoma. It can cause distressing obstructive symptoms for the patient and potentially interfere with monitoring for recurrence. Quality-of-life indicators are known to be very poor in this group of patients; however, there is very little evidence in the literature as to management of this complication.

METHODS

This paper presents an endoscopic day-case surgical procedure to address total posterior nasal stenosis, as conducted in three patients, which involves division of adhesions and removal of the posterior septum and posterior inferior turbinates, without the need for packing or stenting.

RESULTS

In this series, there was resolution of obstructive symptoms and no recurrence of stenosis during follow up (up to 20 months).

CONCLUSION

This endoscopic procedure performed to manage total nasal stenosis differs from those previously described in the literature, as post-operative stenting or packing is not required, and removal of the posterior aspect of the septum is performed routinely.

Nasopharyngeal Carcinoma in Oman: A Descriptive Analysis

OBJECTIVES

We sought to analyze all cases of nasopharyngeal carcinomas (NPC) in Oman to determine the most common clinical presentation, whether it is associated with certain tribes in Oman, and its distribution in different regions of the country. We also looked at the histopathological diagnosis, treatment modality, recurrence, and metastasis.

METHODS

This retrospective chart analysis was performed using the data of all patients with NPC who presented to the Al Nahdha Hospital (the main tertiary hospital of head and neck surgery in Oman) from January 2003 until August 2011.

RESULTS

Twenty-six cases of NPC were included in the final study population. Muscat (the capital city of Oman) had the highest number of cases followed by the Ash Sharqiyah, Al-Batinah, and Dhofar regions. The largest number of cases were found in the Al-Balushi tribe. Cases had a bimodal distribution within two age groups (20-30 years and 50-60 years). Follow-up ranged between six months and seven years.

CONCLUSION

Neck mass and nasal symptoms were the most common presentations of NPC in Oman. Further studies, with a larger sample size are required in order to support our results.

Application of circulating plasma/serum EBV DNA in the clinical management of nasopharyngeal carcinoma

Elevated levels of circulating cell-free Epstein-Barr virus (EBV) DNA have been detected in plasma and serum samples from nasopharyngeal cancer (NPC) patients by quantitative real time PCR (qPCR) test. This qPCR test for circulating EBV DNA was found to be useful in the clinical management of NPC patients. For instance, EBV DNA qPCR test has good sensitivity and specificity in the detection of NPC at disease onset. Increase of the viral DNA load was found in NPC patients at late stages of disease. High EBV DNA load at disease onset or detectable viral load post-treatment was associated with poor survival or frequent relapse in NPC patients. Residual EBV DNA load after primary treatment could be a useful indicator to justify adjuvant chemotherapy. The qPCR test might also be applied to define a poor prognostic group in patients at early stage (I/II) for implementing concurrent chemo-radiotherapy (chemo-RT) to improve patients' outcome. The test is also useful to monitor distant metastases or response to radiotherapy, chemo-RT or surgery. Supplementary tests, however, are needed to pick up EBV negative WHO type I NPC and test improvement is needed to increase sensitivity in detecting stage I disease and local recurrence.