Promising Efficacy With Bevacizumab Plus Pembrolizumab for Platinum-Resistant Nasopharyngeal Carcinoma

According to phase 2 study results, the addition of bevacizumab to pembrolizumab demonstrated superior efficacy to pembrolizumab alone among patients with platinum-resistant recurrent or metastatic nasopharyngeal carcinoma.

“Previous studies have shown that adding anti-VEGF treatment to PD-1 inhibition treatment strategies improves tumour response,” stated Wan-Qin Chong, MBBS, National University Cancer Institute, Singapore, and coauthors. In this trial, study authors “aimed to compare the efficacy of pembrolizumab, a PD-1 inhibitor, with or without bevacizumab, a VEGF inhibitor, in nasopharyngeal carcinoma.” 

In this open-label study, 48 patients with platinum-resistant recurrent or metastatic nasopharyngeal carcinoma were randomized on a 1-to-1 basis to receive either 200 mg pembrolizumab every 21 days alone (n = 21) or in combination with 7.5 mg/kg of once weekly bevacizumab (n = 24) for up to 32 cycles or until disease progression or unacceptable toxicity. The primary end point was objective response rate (ORR). A key secondary end point was safety. 

At a median follow-up of 28.3 months, the ORR was 58.3% in the bevacizumab plus pembrolizumab arm and 12.5% in the pembrolizumab monotherapy arm (95% confidence interval [CI], 1.54 to 14.18; P = .0010). Grade 3 treatment-related adverse events occurred in 29% of patients in the bevacizumab plus pembrolizumab arm and 8% of patients in the pembrolizumab monotherapy arm. The most common severe or grade 3/4 treatment-related adverse events included thrombosis or bleeding, transaminitis, colitis, cytopenias, dermatological toxicity, hypertension, and proteinuria. No grade 4 treatment-related adverse events or treatment-related deaths occurred in either treatment arm. 

“Pembrolizumab in combination with bevacizumab was more efficacious than pembrolizumab monotherapy, with manageable toxicities in platinum-resistant nasopharyngeal carcinoma,” concluded Dr Chong et al. “If validated in a phase 3 trial, the combination therapy could be a new standard of care in this population of patients.” 

Source: 

Chong WQ, Low JL, Tay JK, et al. Pembrolizumab with or without bevacizumab in platinum-resistant recurrent or metastatic nasopharyngeal carcinoma: A randomised, open-label, phase 2 trial. Lancet Oncol. Published online: January 15, 2025. doi: 10.1016/S1470-2045(24)00677-6