Randomized phase 2 trial of pembrolizumab with or without bevacizumab for platinum-resistant recurrent or metastatic nasopharyngeal carcinoma

Vascular endothelial growth factor (VEGF) is overexpressed in nasopharyngeal carcinoma (NPC) and suppresses the antitumor immune response. A randomized phase 2 trial at two centers in Singapore evaluated the PD-1 inhibitor pembrolizumab with or without the VEGF inhibitor bevacizumab for platinum-resistant recurrent or metastatic (R/M) NPC. The primary endpoint was objective response rate (ORR) assessed by independent radiologists. The ORR was 58.3% with pembrolizumab plus bevacizumab versus 12.5% with pembrolizumab monotherapy (RR 4.67; p=0.0010). Grade 3 treatment-related adverse events were seen in 29% of patients in the pembrolizumab plus bevacizumab group and 8% of patients in the pembrolizumab monotherapy group. There were no grade 4 or 5 TRAEs. The authors conclude that among patients with platinum-resistant R/M NPC, pembrolizumab plus bevacizumab was more efficacious than pembrolizumab monotherapy, with manageable toxicities.