Predictive and prognostic role of early apolipoprotein A‐I alteration in recurrent or metastatic nasopharyngeal carcinoma patients treated with anti‐PD‐1 therapy

BACKGROUND: The primary objective of this study was to evaluate the predictive and prognostic value of serum lipids in recurrent or metastatic nasopharyngeal carcinoma (R/M NPC) patients received anti‐PD‐1 therapy. MATERIALS AND METHODS: Patients treated with anti‐PD‐1 therapy (monotherapy or combined with chemotherapy) from two clinical trials (CAPTAIN and CAPTAIN‐1st study) were included. Serum lipids were measured at baseline and after two cycles of treatment. We examined the impact of both baseline and post‐treatment lipid levels on objective response rate (ORR), progression‐free survival (PFS), and duration of response (DOR). RESULTS: Of 106 patients, 89 patients (84%) were male. The patients' median age was 49 years. An early elevated (after two cycles of treatment) cholesterol (CHO), low‐density lipoprotein cholesterol (LDL‐C), apolipoprotein A‐I (ApoA‐I), and apolipoprotein B (ApoB) were significantly associated with better ORR. Moreover, early elevated CHO, LDL‐C, and ApoA‐I were also positively correlated with DOR and PFS. Further multivariate analysis showed that only early change in ApoA‐I could independently predict PFS (HR, 2.27; 95% CI, 1.11–4.61; p = 0.034). The median PFS for patients with early elevated and reduced ApoA‐I was 11.43 and 1.89 months, respectively. However, baseline lipids levels do not play a significant role in the prognosis and prediction of patients with anti‐PD‐1 treatment. CONCLUSION: Collectively, an early elevation in ApoA‐I was correlated with better outcomes for anti‐PD‐1 therapy in patients with R/M NPC, suggesting that clinicians should consider the early alteration of ApoA‐I as a useful marker in treating R/M NPC patients with anti‐PD‐1.