Immunotherapy for Nasopharyngeal Cancer

Immunotherapy can be used to treat some people with nasopharyngeal cancer (NPC).

Immunotherapy uses medicines to boost a person’s own immune system to find and destroy cancer cells more successfully.

Immunotherapy typically works on specific proteins in the immune system to increase the immune response. They have different, often less frequent, side effects from chemotherapy.

Some immunotherapy drugs, for example, monoclonal antibodies, work in more than one way to control cancer cells and may also be considered targeted drug therapy because they block a specific protein on the cancer cell to keep it from growing.

Immune checkpoint inhibitors for nasopharyngeal cancer

An important part of the immune system is its ability to keep itself from attacking normal cells in the body. To do this, it uses “checkpoints,” proteins on immune cells that need to be turned on (or off) to start an immune response. Cancer cells sometimes use these checkpoints to avoid being attacked by the immune system.

Drugs that target these checkpoints (called checkpoint inhibitors) can be used to treat some people with nasopharyngeal cancer.

PD-1 inhibitors

Pembrolizumab (Keytruda), nivolumab (Opdivo), and toripalimab (Loqtorzi) are drugs that target PD-1, a protein on T cells in the immune system. These drugs are called PD-1 inhibitors.  PD-1 normally helps keep T cells from attacking other cells in the body. By blocking PD-1, these drugs boost the immune response against cancer cells. This may shrink some tumors or slow their growth.

These drugs can be used to treat advanced NPC, including cancer that has returned after treatment (recurrent), cannot be treated with surgery or radiation, or that has spread to other parts of the body (metastatic).

Chemotherapy in combination with a PD-1 inhibitor may be recommended for patients with newly diagnosed advanced NPC.  A PD-1 inhibitor, given alone, may also be an option for patients with advanced NPC that have progressed on chemotherapy. 

Nivolumab is given as an intravenous (IV) infusion, typically every 2 or 4 weeks. Pembrolizumab is given as an IV infusion, typically every 3 or 6 weeks. Toripalimab is given as an IV infusion, typically every 2 or 3 weeks.

Possible side effects of PD-1 inhibitors

Side effects of these drugs can include fatigue, cough, fever, nausea, diarrhea, cough, skin rash, loss of appetite, constipation, muscle and joint pain, and itching.

Other, more serious side effects that occur less often include:

• Infusion reactions: Some people might have an infusion reaction while getting one of these drugs. This is like an allergic reaction, and can include fever, chills, flushing of the face, rash, itchy skin, feeling dizzy, wheezing, and trouble breathing. It’s important to tell your doctor or nurse right away if you have any of these symptoms while getting these drugs.
• Autoimmune reactions: These drugs remove one of the safeguards on the body’s immune system. Sometimes the immune system starts attacking other parts of the body, which can cause serious or even life-threatening problems in the lungs, intestines, liver, hormone-making glands, kidneys, skin, or other organs.

It’s very important to report any new side effects during or after treatment with any of these drugs to your health care team right away. If you have any serious side effects, you might need to stop treatment and take high doses of steroids to suppress your immune system.