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Molecular Diagnostics

Biomarkers of response to camrelizumab combined with apatinib: an analysis from a phase II trial in recurrent/metastatic nasopharyngeal carcinoma

British Journal of Cancer (2025)Cite this article

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Abstract

Background

This study aims to develop a peripheral blood-based model that can predict the response to the combination therapy of camrelizumab and apatinib as a second-line or later-line treatment regimen in patients with recurrent/metastatic nasopharyngeal carcinoma (R/M-NPC).

Methods

We collected peripheral blood routine data from 72 patients with R/M-NPC from two clinical trial studies (NCT04547088, NCT04548271). Utilising the least absolute shrinkage and selection operator Cox regression model, we built a peripheral blood signature and developed a prognostic nomogram through multivariable analysis. Spectral flow cytometry analysed peripheral blood mononuclear cell immunophenotyping.

Results

Six indicators (WBC, MCV, HCT, MCHC, P-LCR, MLR) were included to construct the peripheral blood signature. By combining this signature with Epstein–Barr virus DNA, distant lymph node metastasis and previous PD-1 inhibitor treatment, we constructed a peripheral blood-based nomogram that showed favourable performance. High-risk individuals had lower overall survival than low-risk individuals (P < 0.05). Immunophenotyping revealed that the high-risk individuals had increased monocytic myeloid-derived suppressor cells, Tregs and decreased CD8 effector memory cells (P < 0.05).

Conclusions

We established a model that could predict the prognosis of combined therapy. The model could predict outcomes and reflect the systemic immune and inflammatory status, which is beneficial for risk stratification and therapeutic modification.

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Fig. 1: Correlation between Peripheral blood immune inflammation indices and survival (n = 72).
Fig. 2: Development of peripheral blood signature in R/M-NPC patients (n = 72).
Fig. 3: Nomogram2 based on peripheral blood signature and clinical characteristics (n = 72).
Fig. 4: Comparison of immune cell populations in peripheral blood samples between high- and low-risk R/M-NPC patients stratified by Nomogram2 score (n = 61).

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Data availability

All data included in this study are available upon request by contact with the corresponding author.

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Funding

This study was funded by grants from the National Key Research and Development Program of China (2022YFC2505800, 2022YFC2705005), National Natural Science Foundation of China (No. 32200651, 82203776, 82203125, 82222050, 82272739, 82272882, 82203259, 82173287, 82073003, 82003267, 82002852, 82373258, 82372980, 82361168664, 8247101588, 82473038), Guangdong Basic and Applied Basic Research Foundation (2021B1515230002, 2023B1515120092, 2023A1515010398, 2024A1515013021), Science and Technology Program of Guangzhou (202201011561, 2023A04J2127, 2023A04J2246, 2024B03J1248), Sun Yat-sen University Clinical Research 5010 Program (No. 201315, 2015021, 2017010, 2019023), Innovative Research Team of High-level Local Universities in Shanghai (SSMU-ZLCX20180500), Postdoctoral Innovative Talent Support Program (BX20220361), Planned Science and Technology Project of Guangdong Province (2019B020230002), Science and Technology Projects in Guangzhou (202201011533), Key Youth Teacher Cultivating Program of Sun Yat-sen University (20ykzd24), and Fundamental Research Funds for the Central Universities.

Author information

Author notes

  1. These authors contributed equally: Kaiqi Lan, Shibing Li, Guodong Jia.

Authors and Affiliations

  1. State Key Laboratory of Oncology in South China, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Guangdong Provincial Clinical Research Center for Cancer, Sun Yat-sen University Cancer Center, Guangzhou, China

    Kaiqi Lan, Guodong Jia, Suchen Li, Siyi Xie, Linquan Tang, Haiqiang Mai & Li Yuan

  2. Department of Nasopharyngeal Carcinoma, Sun Yat-sen University Cancer Center, Guangzhou, China

    Kaiqi Lan, Guodong Jia, Suchen Li, Siyi Xie, Linquan Tang, Haiqiang Mai & Li Yuan

  3. Department of Clinical Laboratory, Biomedical Innovation Center, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, China

    Shibing Li

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Contributions

LY and HM contributed to conceptualisation, funding acquisition, supervision and manuscript review and editing. KL, SL and GJ were responsible for data curation, formal analysis, conceptualisation, methodology and writing the original draft. SX and SL conducted data curation and formal analysis. LT performed data curation and methodology. All authors read and approved the final version of the manuscript.

Corresponding authors

Correspondence to Haiqiang Mai or Li Yuan.

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The authors declare no competing interests.

Ethics approval and consent to participate

This study was approved by the Institutional Review Board of Sun Yat-sen University Cancer Center. All patients provided written informed consent prior to the collection of specimens. All methods were performed in accordance with the relevant guidelines and regulations.

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Lan, K., Li, S., Jia, G. et al. Biomarkers of response to camrelizumab combined with apatinib: an analysis from a phase II trial in recurrent/metastatic nasopharyngeal carcinoma. Br J Cancer (2025). https://doi.org/10.1038/s41416-025-03044-y

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