CASE REPORT article

Front. Immunol.

Sec. Cancer Immunity and Immunotherapy

Volume 16 - 2025 | doi: 10.3389/fimmu.2025.1585844

This article is part of the Research TopicOpportunities and Challenges of Head and Neck Cancer Treatment in the Era of Immune Checkpoint InhibitorsView all 16 articles

Long-term Immune Checkpoint Inhibitor Therapy in a Patient With Metastatic Nasopharyngeal Carcinoma: A Case Report

Provisionally accepted
  • 1Faculty of Medical Science, Jinan University, Guangzhou, China
  • 2Department of Radiation Oncology Ⅱ, Clinical Oncology Center, People’s Hospital of Guangxi Zhuang Autonomous Region, Nanning, China
  • 3Department of Radiation Oncology Ⅱ, Clinical Oncology Center, People's Hospital of Guangxi Zhuang Autonomous Region, Nanning, Guangxi Zhuang Region, China

The final, formatted version of the article will be published soon.

Background: Immunotherapy has revolutionized cancer treatment. However, the duration of treatment and the timing of discontinuation are major concerns. Current pivotal trials predominantly advocate for a fixed two-year regimen of immune checkpoint inhibitors (ICIs), exemplified by pembrolizumab and toripalimab, as first-line therapy for patients with advanced malignancies. Alternatively, for specific ICIs, including nivolumab, camrelizumab, and tislelizumab, continuous administration until disease progression has emerged as a favored approach. Nevertheless, whether to discontinue treatment after two years remains intensely debated within the medical community, underscoring the need for further research to clarify optimal treatment durations. Case Presentation: In November 2018, a 44-year-old male presented with a persistent headache. Following a positive nasopharyngeal mucosal biopsy, he was diagnosed with non-keratinizing undifferentiated carcinoma of the nasopharynx cT4N2M0. An Epstein-Barr Virus (EBV) DNA load of 800 copies/mL was detected. The patient completed two cycles of induction chemotherapy with liposomal paclitaxel and nedaplatin, followed by platinum-based concurrent chemoradiotherapy, resulting in a progression-free survival (PFS) of 23.6 months. The EBV DNA load dropped significantly to 190 copies/mL. However, during a routine examination in January 2021, metastases in the lung and mediastinal lymph nodes were detected, and the EBV DNA load was measured at 2200 copies/mL. Consequently, surgical intervention was performed, followed by radiotherapy and two years of ICI treatment. Throughout the ICI maintenance period, the EBV DNA level remained consistently below the limit of detection. Remarkably, three months after treatment discontinuation, the patient exhibited a rebound in EBV DNA (1620 copies/mL). Nevertheless, imaging scans revealed no evidence of tumor progression. Following an ICI rechallenge, the patient's EBV DNA load returned to undetectable levels. The patient continues the ICI therapy and has thus far achieved a PFS of 41.6 months. Conclusion: EBV DNA levels could serve as an informative marker to predict the necessity of therapy discontinuation during immunotherapy maintenance. Notably, a post-discontinuation ICI rechallenge can still yield favorable outcomes potentially accredited to immune memory.

Keywords: Immune checkpoint inhibitor, Immunotherapy, therapy discontinuation, Treatment duration, EBV DNA

Received: 01 Mar 2025; Accepted: 26 May 2025.

Copyright: © 2025 Qing, Lu and Lu. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

* Correspondence: Heming Lu, Department of Radiation Oncology Ⅱ, Clinical Oncology Center, People’s Hospital of Guangxi Zhuang Autonomous Region, Nanning, China

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