Phase III Trial of EBV-DNA-Guided Adaptive Immunotherapy for Advanced Nasopharyngeal Carcinoma

Multicenter, Prospective Phase III Clinical Trial of EBV-DNA-Guided Adaptive Immunotherapy for Locoregionally Advanced Nasopharyngeal Carcinoma

This trial evaluated the efficacy of two adjuvant regimens following identical induction and concurrent chemoradiotherapy (IC+CCRT) in locoregionally advanced nasopharyngeal carcinoma (LANPC) patients with persistent EBV DNA positivity or stable disease after three IC cycles. The control arm received adjuvant adebrelimab, while the experimental arm received adebrelimab plus capecitabine.

Study Overview

• Status: Not yet recruiting
• Conditions: Nasopharyngeal Cancinoma (NPC); Nasopharangeal Cancer
• Intervention / Treatment: Radiation: Intensity-modulated radiotherapy; Drug: Adebrelimab (PD-L1 inhibitor); Drug: Cisplatin (100mg/m2); Drug: Capecitabine

Detailed Description

This study will enroll patients with stage II-III LANPC (AJCC 9th edition, excluding T3N0-1). After three cycles of induction chemotherapy (gemcitabine, cisplatin, and adebrelimab), eligible patients with persistent EBV DNA or stable disease will be randomized 1:1. All patients will undergo CCRT followed by adjuvant therapy. The control arm will receive five cycles of adebrelimab. The experimental arm will receive five cycles of adebrelimab in combination with capecitabine, which will be administered for one year.

• Study Type: Interventional
• Enrollment (Estimated): 516
• Phase: Phase 3

Contacts and Locations

• Study Contact: Name: Jun Ma, M.D; Phone Number: +862087343469; Email: majun2@mail.sysu.edu.cn
• Study Contact Backup: Name: Lei Chen, M.D.; Email: chenlei@sysucc.org.cn

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: Adult; Older Adult
• Accepts Healthy Volunteers: No

Description

Inclusion Criteria:

1. Age ≥18 and ≤65 years
2. Patients with histologically confirmed non-keratinizing nasopharyngeal carcinoma according to WHO criteria.
3. Eastern Cooperative Oncology Group performance score of 0-1.
4. Tumor staged as II-III disease (AJCC 9th edition), excluding T3N0-1.
5. Adequate marrow function: white blood cell count > 4 × 10⁹/L hemoglobin >90g/L and platelet count >100×10⁹/L

6. Adequate hepatic and renal function：

   • Total bilirubin ≤ 1.5 × upper limit of normal (ULN)
   • Alanine Aminotransferase (ALT)/Aspartate Aminotransferase (AST) ≤2.5×ULN
   • Alkaline phosphatase ≤ 2.5 × ULN
   • clearance rate ≥ 60 ml/min

7. Other laboratory and clinical criteria

   • Normal thyroid function, serum amylase and lipase, pituitary hormone levels, inflammatory markers, cardiac enzyme tests and electrocardiogram (ECG)
   • For patients aged >50 years with a history of smoking, normal pulmonary function test (PFT) results are required
   • For patients with abnormal ECG findings or a prior history of cardiovascular disease (not meeting any exclusion criteria listed in Item 8), additional assessments including myocardial function evaluation and cardiac ultrasound (echocardiography) must be performed, with results within normal limits
8. Patients with persistent EBV DNA positivity or stable disease following 3 cycles of induction chemotherapy (gemcitabine, cisplatin, and adebrelimab).
9. Patients must be informed of the investigational nature of this study and give written informed consent, and be willing and able to comply with the study schedule, including follow-up visits, treatment procedures, laboratory testing, and other protocol-related requirements.
10. Women of childbearing potential (WOCBP) must be willing to adhere to effective contraception during treatment and for 1 year after the last dose of study drug (e.g., condoms, physician-guided regular use of oral contraceptives).

Exclusion Criteria:

1. Disease progression after induction chemotherapy
2. Positive for hepatitis B surface antigen (HBsAg) with hepatitis B virus DNA >1×103 copies/mL, positive for anti-hepatitis C virus (HCV) antibody , positive for anti-hepatitis C virus (HCV) antibody
3. Positive for anti-HIV antibody or diagnosed with acquired immunodeficiency syndrome (AIDS).
4. Active pulmonary tuberculosis: Patients with a history of active tuberculosis within the past year should be excluded regardless of treatment status. Patients with a history of active pulmonary tuberculosis more than one year prior should also be excluded, unless they received confirmed and regular anti-tuberculosis treatment.
5. Active, known, or suspected autoimmune diseases, including but not limited to uveitis, colitis, hepatitis, hypophysitis, nephritis, vasculitis, systemic lupus erythematosus, hyperthyroidism, hypothyroidism, and asthma requiring bronchodilators. Type I diabetes, hypothyroidism treated with replacement therapy, and skin disease that doesn't require systemic treatment (e.g., vitiligo, psoriasis, or alopecia) are allowed.
6. History of interstitial lung disease or pneumonia requiring oral or intravenous corticosteroids within the past year; use of vancomycin within the past month.
7. Ongoing chronic systemic corticosteroid therapy (equivalent to or greater than prednisone >10mg per day) or any other immunosuppressive therapy. Patients received inhale or topical corticosteroid are allowed.

8. Uncontrolled cardiac conditions, such as:

   • Heart failure with New York Heart Association (NYHA) classification ≥ Class II;
   • Unstable angina;
   • History of myocardial infarction within the past year;
   • Supraventricular or ventricular arrhythmias requiring treatment or intervention
9. Pregnant or breastfeeding women (pregnancy testing should be considered for women of childbearing potential with active sexual life)
10. History or presence of other malignancies, except for adequately treated non-melanoma skin cancer, carcinoma in situ of the cervix, and papillary thyroid carcinoma.
11. Known hypersensitivity to macromolecule protein products or any component of adebrelimab.
12. Active infections requiring systemic treatment within 1 week prior to enrollment.
13. Administration of live vaccines within 30 days prior to the first dose of adebrelimab.
14. Factors significantly affecting the absorption of oral drugs, such as inability to swallow, chronic diarrhea, or intestinal obstruction.
15. History of organ transplantation or hematopoietic stem cell transplantation.
16. Any other condition assessed by the investigator as potentially compromising patient safety or compliance, such as severe illnesses requiring urgent treatment (including psychiatric disorders), significantly abnormal laboratory values, or other psychological, familial, or social risk factors.

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Treatment
• Allocation: Randomized
• Interventional Model: Parallel Assignment
• Masking: None (Open Label)

Number of Arms

2

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Experimental: adebrelimab plus capecitabine; Patients will receive definitive intensity-modulated radiotherapy (IMRT) of 6996cGy in 33 fractions. Concurrent cisplatin of 100mg/m2 will be administered every 3 weeks for 2 cycles during IMRT. Subsequently, adjuvant therapy with adebrelimab (1200 mg, d1) will be initiated for a total of 5 cycles, and capecitabine will be administered at 650 mg/m² orally twice daily for one year.	Radiation: Intensity-modulated radiotherapy; Definitive intensity-modulated radiotherapy (IMRT) of 6996cGy will be given in 33 fractions.; Drug: Adebrelimab (PD-L1 inhibitor); Adebrelimab 1200mg will be given every 3 weeks for 5 cycles in adjuvant chemotherapy; Drug: Cisplatin (100mg/m2); Induction cisplatin 80mg/m2, every 3 weeks for 3 cycles before radiation; Concurrent cisplatin 100mg/m2, every 3 weeks for 2 cycles during radiation; Drug: Capecitabine; Capecitabine was administered at 650 mg/m² orally twice daily for one year.
Active Comparator: adebrelimab; Patients will receive definitive intensity-modulated radiotherapy (IMRT) of 6996cGy in 33 fractions. Concurrent cisplatin of 100mg/m2 will be administered every 3 weeks for 2 cycles during IMRT. Subsequently, adjuvant therapy with adebrelimab (1200 mg, d1) will be initiated for a total of 5 cycles.	Radiation: Intensity-modulated radiotherapy; Definitive intensity-modulated radiotherapy (IMRT) of 6996cGy will be given in 33 fractions.; Drug: Adebrelimab (PD-L1 inhibitor); Adebrelimab 1200mg will be given every 3 weeks for 5 cycles in adjuvant chemotherapy; Drug: Cisplatin (100mg/m2); Induction cisplatin 80mg/m2, every 3 weeks for 3 cycles before radiation; Concurrent cisplatin 100mg/m2, every 3 weeks for 2 cycles during radiation

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Failure-free survival (FFS)	From date of randomization until the date of first documented locoregional recurrence, distant metastasis, or death from any cause, whichever occurred first, assessed up to 74 months	3 year

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Adverse events (AEs) and serious adverse events (SAEs)	Graded according to CTCAE V5.0.	3 years
Overall survival (OS)	From date of randomization until the date of death from any cause, whichever came first, assessed up to 74 months	3 years
Distant metastasis-free survival (DMFS)	From date of randomization until the date of first documented distant metastasis, whichever occurred first, assessed up to 74 months.	3 years
Locoregional recurrence-free survival (LRRFS)	From date of randomization until the date of first documented locoregional recurrence, whichever occurred first, assessed up to 74 months.	3 years
Tumor response	Evaluation of tumor response as CR, PR, SD, PD, NA by clinicians	the time of completion of induction chemotherapy, radiotherapy, and adjuvant immunotherapy; from the date of enrollment until the date of the last time that tumorimaging and assessment of disease has been done, assessed up to 74 weeks
Quality of life (QoL)	The change of QoL from randomization to the start of radiotherapy, the end of radiotherapy, 13-16 weeks after radiotherapy, 2 years and 3 years after randomization. The EORTC QoL questionnaire-C30 (EORTC QLQ-C30）version 3.0 will be used. This questionnaire comprises 30 questions, 24 of which are aggregated into nine multi-question scales, that is, five functioning scales (e.g., physical), three symptom scales (e.g., fatigue) and one global health status scale. The remaining six single-question (e.g., dyspnoea) scales assess symptoms. These 15 scales will be scored according to the official Scoring Manual. For the functional scales and the global health status scale, a higher score represents a better level of functioning or quality of life. For the symptom scales, a higher score indicates a greater severity of symptoms.	week 1, 6, 24, 60, 72
Failure-free survival (FFS) within different subgroups	analyses for FFS will be performed within the following subgroups: Epstein-Barr virus (EBV) DNA (≤4000copies/ml vs. >4000copies/ml), different PD-L1 expression levels, age, gender, performance status, T category, N category, and stage.	3 years

Other Outcome Measures

Outcome Measure	Measure Description	Time Frame
Correlation between pre-treatment PD-L1 expression level and FFS	Pre-treatment PD-L1 expression level of tumor cell is evaluated centrally by means of immunohistochemical testing.	3 years
Evaluate failure-free survival in the subgroup of plasma Epstein-Barr virus DNA level	Subgroup analysis	3 years

Collaborators and Investigators

• Sponsor: Sun Yat-sen University

Study record dates

Study Major Dates

• Study Start (Estimated): December 1, 2025
• Primary Completion (Estimated): December 1, 2029
• Study Completion (Estimated): May 23, 2031

Study Registration Dates

• First Submitted: November 16, 2025
• First Submitted That Met QC Criteria: November 16, 2025
• First Posted (Actual): November 20, 2025

Study Record Updates

• Last Update Posted (Actual): November 20, 2025
• Last Update Submitted That Met QC Criteria: November 16, 2025
• Last Verified: November 1, 2025

More Information

Terms related to this study

• Keywords: capecitabine; chemoradiotherapy; PD-L1 antibody; adebrelimab
• Additional Relevant MeSH Terms: Antineoplastic Agents, Immunological; Antineoplastic Agents; Molecular Mechanisms of Pharmacological Action; Heterocyclic Compounds, 1-Ring; Heterocyclic Compounds; Therapeutics; Nucleic Acids, Nucleotides, and Nucleosides; Pharmacologic Actions; Chemical Actions and Uses; Therapeutic Uses; Inorganic Chemicals; Chlorine Compounds; Nitrogen Compounds; Deoxycytidine; Cytidine; Pyrimidine Nucleosides; Pyrimidines; Nucleosides; Uracil; Pyrimidinones; Platinum Compounds; Radiotherapy; Deoxyribonucleosides; Fluorouracil; Radiotherapy, Conformal; Radiotherapy, Computer-Assisted; Capecitabine; Immune Checkpoint Inhibitors; Cisplatin; Radiotherapy, Intensity-Modulated
• Other Study ID Numbers: 2025-FXY-346-FLK

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: NO
• IPD Plan Description: Complete de-identified patient data set will be submitted onto an online platform.

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No