Treatment Strategies for Metastatic Nasopharyngeal Carcinoma Patients with Immune Therapy Advantage: A Comparative Case Report and Literature Review

Zikun LiYuxiang He^*

• Xiangya Hospital, Central South University, Changsha, China

This study examines two cases of stage IVb metastatic nasopharyngeal carcinoma. It conducts a literature review to investigate the role of radiotherapy in the treatment regimen for patients with complete remission following induced chemotherapy and immunotherapy in de novo metastatic nasopharyngeal carcinoma (dmNPC). Case 1 involved a dmNPC patient (T4N3M1) with multi-organ metastases and ECOG PS 2, who showed significant tumor reduction after one cycle of immunotherapy and non-platinum chemotherapy. Despite financial constraints, the patient survived 25 months with a good quality of life. Case 2 describes another dmNPC patient (T3N2M1) with multi-organ metastases and ECOG PS 0, who received chemotherapy, immunotherapy, and radi-otherapy but faced rapid progression and died after 21 months. Immunotherapy com-bined with chemotherapy has become the standard treatment for patients with mNPC. For patients who have achieved remission after induction chemotherapy, radiotherapy to the primary tumor may benefit survival. However, immunotherapy alone may achieve substantial efficacy in patients with metastases who exhibit immunotherapy advantage. Radiotherapy (RT) can improve local control and enhance tumor antigen release, complementing immunotherapy; however, it may also damage immune cells, leading to exhaustion and resistance. Thus, balancing RT and chemotherapy is essential to enhance immune synergy and avoid exhaustion.