Efficacy and safety of PD-1 inhibitors combined with anti-angiogenic agents in patients with recurrent or metastatic nasopharyngeal carcinoma: a systematic review and meta-analysis

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OBJECTIVES: PD-1 inhibitors have shown significant progress in treating recurrent or metastatic nasopharyngeal carcinoma (R/M NPC); however, the optimal second-line regimen remains unclear. Studies have suggested that the combination of PD-1 inhibitors and anti-angiogenic agents shows synergistic potential in advanced nasopharyngeal carcinoma. This meta-analysis aims to assess the efficacy and safety of this combination therapy. MATERIALS AND METHODS: We performed an extensive search of PubMed, Embase, Cochrane Library, and Web of Science databases up to May 13, 2025. Stata 18.0 was used to analyze the eligible data. RESULTS: Eight clinical trials involving 271 cases were included. The objective response rate (ORR) was 49% (95% CI: 39-59%), the disease control rate (DCR) was 80% (95% CI: 74-85%), the one-year progression-free survival rate (1-year PFS) was 39% (95% CI: 29-49%), and the one-year overall survival rate (1-year OS) was 73% (95% CI: 58-85%). The most common grade 3-4 adverse event was hypothyroidism, occurring in 36% of patients. Additionally, further subgroup analysis showed that combination therapy was more effective in patients who had not previously received PD-1 inhibitors (P = 0.003). CONCLUSION: In summary, PD-1 inhibitors combined with anti-angiogenic agents exhibited notable effectiveness with a manageable safety profile. Additional phase III randomized controlled trials (RCTs) are needed to confirm these findings.

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