Top Line: Induction chemotherapy followed by concurrent chemoradiation (CRT) is still considered the standard approach for locally advanced nasopharyngeal carcinoma (NPC), but several recent trials have threatened to disrupt this approach.
The Study: Two particular themes have been the addition of immunotherapy (sintilimab, camrelizumab) and the omission of concurrent chemotherapy during the radiation phase. DIAMOND was a multicenter, randomized, phase 3 trial that sought to determine if adding the PD-1 inhibitor, toripalimab, to induction chemotherapy and dropping concurrent cisplatin resulted in non-inferior failure free survival and less toxicity. Note that toripalimab already has an established role in NPC with a NCCN category 1/preferred recommendation for recurrent or metastatic disease. The trial included 532 patients planned to receive induction chemo and CRT for locally advanced NPC. The standard arm consisted of induction gem/cis followed by radiation and concurrent cisplatin. In both arms, toripalimab was administered every 3 weeks during induction chemo, radiation, and as maintenance. In the experimental arm, concurrent cisplatin was dropped during radiation. At 3 years, failure free survival was deemed non-inferior without concurrent cisplatin (88.3% v 87.6%. Locoregional failure free survival (92.9% v 93.6%) and distant failure free survival (93.2% v 91.6%) were also similar. The co-primary endpoint of all-grade vomiting was significantly lower by more than half with cisplatin omission (26.2% v 59.8%). Furthermore, patient-reported QOL and tolerability were superior when cisplatin was omitted.
TBL: In the DIAMOND trial, when toripalmiab was given during standard therapy for locally advanced NPC, omitting cisplatin during radiation did not compromise disease or survival outcomes and reduced toxicity. | The Diamond Study Group, JAMA 2025
The Study: Two particular themes have been the addition of immunotherapy (sintilimab, camrelizumab) and the omission of concurrent chemotherapy during the radiation phase. DIAMOND was a multicenter, randomized, phase 3 trial that sought to determine if adding the PD-1 inhibitor, toripalimab, to induction chemotherapy and dropping concurrent cisplatin resulted in non-inferior failure free survival and less toxicity. Note that toripalimab already has an established role in NPC with a NCCN category 1/preferred recommendation for recurrent or metastatic disease. The trial included 532 patients planned to receive induction chemo and CRT for locally advanced NPC. The standard arm consisted of induction gem/cis followed by radiation and concurrent cisplatin. In both arms, toripalimab was administered every 3 weeks during induction chemo, radiation, and as maintenance. In the experimental arm, concurrent cisplatin was dropped during radiation. At 3 years, failure free survival was deemed non-inferior without concurrent cisplatin (88.3% v 87.6%. Locoregional failure free survival (92.9% v 93.6%) and distant failure free survival (93.2% v 91.6%) were also similar. The co-primary endpoint of all-grade vomiting was significantly lower by more than half with cisplatin omission (26.2% v 59.8%). Furthermore, patient-reported QOL and tolerability were superior when cisplatin was omitted.
TBL: In the DIAMOND trial, when toripalmiab was given during standard therapy for locally advanced NPC, omitting cisplatin during radiation did not compromise disease or survival outcomes and reduced toxicity. | The Diamond Study Group, JAMA 2025