S533
Clinical – Head & neck
ESTRO 2026
advanced nasopharyngeal carcinoma (LA-NPC)1–3. Material/Methods: Individual-patient data from the phase 2 trial PLATINUM (NCT03984357)1 and phase 3 randomized controlled trials CONTINUUM (NCT03700476)2 and DIAMOND (NCT04907370)3 including 894 LA-NPC patients treated by PD-1 blockade plus chemoradiotherapy (CRT) were pooled. Immune- related adverse events (irAEs) involving thyroid, liver, pancreas, and cardiac function throughout treatment were assessed (n=673). Kaplan-Meier curves across different irAE classifications were compared using the log-rank test (n=758); baseline correlates were determined by the Breslow test. Adjuvant PD-1 blockade was categorized into short-term ( ≤ 4 cycles), intermediate-term (5-9 cycles), and long-term ( ≥ 10 cycles) groups. Survival outcomes were compared after propensity-score matching. Financial difficulty was assessed by the EORTC-C30 v3.0 questionnaire. Results: Overt hypothyroidism and its recurrence increased progressively throughout treatment, with a mean of 77% converted from hyperthyroidism. Recurrent/converted hypothyroidism were classified as hypoT-type disorder. Elevated AST and ALT declined consistently, averaging 5% in the adjuvant phase. Elevated amylase (22.4%)/lipase (19.3%) distinctly peaked before/during the adjuvant phase. In the adjuvant phase, 20.3% of patients exhibited elevated myocardial enzymes while maintaining a normal ECG. Among all irAEs, only hypoT-type disorder (n=196 [occurrence] vs. 477 [absence]) was associated with improved 3-year failure-free survival (FFS; 93.8% vs. 85.9%; p=0.001), overall survival (OS; 99.0% vs. 95.9%; p=0.027), and distant metastasis-free survival (DMFS; 97.4% vs. 90.9%; p=0.001). HypoT-type disorder was more frequent in younger patients, female, those with undifferentiated nonkeratinizing pathology, and non- smokers (p ≤ 0.037). In patients receiving concurrent cisplatin (n=226), short-term adjuvant PD-1 blockade was inferior only to long-term use for OS (p=0.014). In those without concurrent cisplatin (n=221), short-term treatment showed significant disadvantages in FFS, OS, and DMFS compared with intermediate-term (p ≤ 0.012) and long-term use (p ≤ 0.011). Patients receiving short-term adjuvant PD-1 blockade, in either group, reported clinically and statistically greater financial difficulties (p ≤ 0.021). Adjuvant PD-1 blockade was proposed to be reduced to 5 or 9 cycles for LA- NPC patients receiving CRT with or without concurrent cisplatin, respectively, which alongside omitting amylase, ASL/ALT, and ECG in the adjuvant phase, yielded average proportional savings of 36.3% in USD per patient.
Proffered Paper 277 Cost-minimization of testing and therapeutic simplification for PD-1 blockade in nasopharyngeal carcinoma: A pooled analysis of three clinical trials Cheng Xu 1 , Yu-Zhe Wang 2 , Xu Liu 1 , Yuan Zhang 1 , Ren- Jia Shu 1 , Liang-Fang Shen 3 , Feng Jin 4 , Kun-Yu Yang 5 , Guang-Yuan Hu 6 , Xiao-Dong Zhu 7 , Ying Wang 8 , Ning Zhang 9 , De-Sheng Hu 10 , Shao-Jun Lin 11 , Guo-Rong Zou 12 , Xiao-Zhong Chen 13 , Shao-Wen Xiao 14 , Jin-Gao Li 15 , Nian-Yong Chen 16 , Hai-Jun Wu 17 , Mei Shi 18 , Ji-Bin Li 19 , Ling-Long Tang 1 , Ying Sun 1 , Jun Ma 1 1 Department of Radiation Oncology, Sun Yat-sen University Cancer Center, Guangzhou, China. 2 Zhongshan School of Medicine, Sun Yat-sen University, Guangzhou, China. 3 Department of Radiation Oncology, Xiangya Hospital of Central South University, Changsha, China. 4 Department of Oncology, The Affiliated Hospital of Guizhou Medical University, Guiyang, China. 5 Department of Oncology, Cancer Center, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China. 6 Department of Oncology, Tongji Hospital, Tongji Medical College, Huazhong University of Technology and Science, Wuhan, China. 7 Department of Radiation Oncology, Guangxi Medical University Cancer Hospital, Nanning, China. 8 Radiation Oncology Centre, Chongqing University Cancer Hospital, Chongqing, China. 9 Department of Nasopharyngeal Oncology, First People's Hospital of Foshan, Foshan, China. 10 Department of Radiation Oncology, Hubei Cancer Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China. 11 Department of Radiation Oncology, Cancer Hospital of Fujian Medical University, Fuzhou, China. 12 Department of Oncology, The Affiliated Panyu Central Hospital, Guangzhou MedicaiUniversity, Guangzhou, China. 13 Department of Head and Neck Radiotherapy, Zhejiang Cancer Hospital, Hangzhou, China. 14 Department of Radiation Oncology, Peking University Cancer Hospital & Institute, Beijing, China. 15 Department of Radiation Oncology, Jiangxi Cancer Hospital & Institute, Second Affiliated Hospital of Nanchang Medical College, Nanchang, China. 16 Department of Radiation Oncology, Cancer Center, West China Hospital, Chengdu, China. 17 Department of Oncology, Xiangya Hospital, Central South University, Changsha, China. 18 Department of Radiation Oncology, Xijing Hospital, Fourth Military Medical University, Xi'an, China. 19 Clinical Trials Center, Sun Yat-sen University Cancer Center, Guangzhou, China Purpose/Objective: This study aims to propose a cost-minimization strategy to address the financial toxicity related to prolonged adjuvant PD-1 blockade in locoregionally
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