Camrelizumab, apatinib plus induction chemotherapy and concurrent chemoradiotherapy in stage N3 nasopharyngeal carcinoma

Abstract Antiangiogenic agent apatinib has shown synergetic antitumoral efficacy in combination with camrelizumab in several solid tumors. Immunotherapy combination with standard treatment regimen was reported benefit in nasopharyngeal carcinoma (NPC), however, N3 patients did not show the benefit. In this phase II clinical trial (ChiCTR2000032317), 49 eligible patients with stage TanyN3M0 NPC were enrolled and received the combination of induction chemotherapy, camrelizumab and apatinib followed by chemoradiotherapy. After induction therapy, all patients had objective response, including 13 patients (26.5%) with complete response. After a median follow-up of 28.7 months, the primary endpoint of 1-year distant metastasis-free survival was met (98%, 95% confidence interval 88–100). The 2-year failure-free survival was 96%. Grade ≥ 3 toxicity appeared in 32 (65.3%) patients, with the most common being mucositis (14[28.6%]) and nausea/vomiting (9[18.4%]). Camrelizumab and apatinib in combination with induction chemotherapy shows promising distant metastasis control with acceptable safety profile in stage TanyN3M0 NPC.