LDRT and Chemoimmunotherapy in NPC With Liver Metastasis

Exclusion Criteria22

• Patients with tumor recurrence at the primary site who have previously received radical radiotherapy.
• Tumor invasion involving major blood vessels, with a high risk of significant bleeding as assessed by the investigator.
• Systemic anticancer therapy, including hormone therapy, administered within 28 days prior to the initiation of the study treatment.
• Previous treatment with immune checkpoint inhibitors (e.g., PD-1/PD-L1, CTLA-4).
• Patients with active autoimmune diseases or a history of autoimmune diseases with a risk of recurrence.
• Known history of other malignancies (except cured basal cell carcinoma or carcinoma in situ of the cervix).
• Conditions requiring systemic corticosteroid therapy (equivalent to \>10 mg/day of prednisone or similar medications) or other immunosuppressive therapy within ≤14 days prior to treatment.
• Uncontrolled diabetes or laboratory abnormalities ≥Grade 1 in potassium, sodium, or corrected calcium levels despite standard treatment, or ≥Grade 3 hypoalbuminemia within ≤14 days before treatment.
• History of the following diseases: interstitial lung disease, non-infectious pneumonitis, or uncontrolled diseases, including pulmonary fibrosis or acute lung disease.
• Severe chronic or active infections requiring systemic antibiotics, antifungals, or antivirals within ≤14 days before the first dose of the investigational drug (including tuberculosis infection).
• Known history of HIV infection.
• Untreated chronic hepatitis B patients or hepatitis B virus (HBV) carriers with HBV DNA ≥500 IU/mL, or active hepatitis C virus (HCV) carriers.
• Any major surgery requiring general anesthesia within ≤28 days prior to treatment.
• Previous allogeneic stem cell transplantation or organ transplantation.
• Any cardiovascular risk factors, including: cardiac chest pain that restricts daily instrumental activities ≤28 days before treatment. Symptomatic pulmonary embolism within ≤3 months before treatment. Acute myocardial infarction within ≤6 months before treatment. History of heart failure meeting New York Heart Association (NYHA) Class III or IV within ≤6 months before treatment. Grade ≥2 ventricular arrhythmias within ≤6 months before treatment. History of cerebrovascular accident within ≤6 months before the first dose of the investigational drug.
• Evident bleeding tendencies or clinically significant bleeding symptoms ≤28 days prior to randomization, including but not limited to gastrointestinal bleeding, nasal bleeding (excluding epistaxis or retrograde blood-stained nasal discharge), and persistent bleeding disorders or coagulopathy.
• Known allergy to any component of the investigational drug or a history of severe hypersensitivity to other monoclonal antibodies.
• Peripheral neuropathy of Grade ≥2 as defined by NCI CTCAE v5.0.
• Administration of live vaccines within ≤4 weeks prior to treatment.
• Underlying medical conditions (including laboratory abnormalities) or alcohol/drug abuse or dependency that could impair drug administration, interpretation of drug toxicity, or adverse events (AEs), or could compromise study compliance or execution.
• Pregnant or breastfeeding women.
• Other factors deemed by the investigator that could lead to the premature termination of the study, such as other severe illnesses, significant laboratory abnormalities, or family/social factors that could affect participant safety or the collection of study data.