Epstein-Barr virus (EBV)-related Nasopharyngeal carcinoma (NPC) is a highly chemo-radiosensitive cancer. However, when relapsing without surgical or reirradiation options, NPC carries a dismal prognosis; survival >2 years being reported in 7-14% metastatic pts (1,2). We have previously achieved disease control using autologous EBV-specific cytotoxic T lymphocytes (CTL) in refractory/relapsed pts following conventional treatments (3). The aim of the present study was to evaluate outcomes in pts receiving T-cell therapy after first line chemotherapy (CT) for recurrent disease.
Sixteen patients (13 males, median age 41 yrs) with metastatic (n = 12; 7/12 with visceral metastasis, and 5/12 with bone and nodes lesions) or locally recurrent (n = 4) NPC received 2 administrations of EBV-specific CTL at a total cell dose/infusion of 1.5-3 x 108, following completion of first line CT. The best response after first-line CT had been progressive disease (PD) in 4 pts, stable disease (SD) in 3, partial response (PR) in 5 and complete response (CR) in 4.
No severe adverse events were recorded, following CTL therapy. Among patients in CR after first-line CT, 3 remain in CR at 58, 76 and 77+ months, while one patient relapsed, but attained a long-lasting CR after treatment with 2nd-line CT. In the 12 patients treated with persistent disease (PR, SD, PD), the best response observed after CTL therapy, in some cases (3/12) associated with 1subsequent line of CT or radiotherapy, was PD in 8 patients, and CR (range 39-78+ months) in 4. At a median follow-up of 64 months, 8/16 patients are alive with no evidence of disease. Among the factors associated with positive outcome are response to first-line CT, and metastatic disease with limited tumor burden.
EBV-specific CTL therapy administered following first line CT for recurrent NPC, is safe and associated with remarkable clinical benefit in some patients, including long-lasting CR.
Clinical trial identification
Legal entity responsible for the study
Fondazione IRCCS Policlinico San Matteo Pavia.
Fondazione IRCCS Policlinico San Matteo, Ricerca Corrente RCR.
All authors have declared no conflicts of interest.