Case Report
Copyright ©The Author(s) 2025. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Oncol. Feb 24, 2025; 16(2): 95642
Published online Feb 24, 2025. doi: 10.5306/wjco.v16.i2.95642
Denosumab combined with immunotherapy, radiotherapy, and granulocyte-macrophage colony-stimulating factor for the treatment of metastatic nasopharyngeal carcinoma: A case report
Wei-Wu Chen, Yue-Hong Kong, Li-Yuan Zhang
Wei-Wu Chen, Yue-Hong Kong, Li-Yuan Zhang, Center for Cancer Diagnosis and Treatment, The Second Affiliated Hospital of Soochow University, Suzhou 215000, Jiangsu Province, China
Author contributions: Chen WW and Kong YH contributed equally to this work, contributed to study conception and design, enrolled and took care of the patient, collected clinical data, performed the experiments, analyzed the data, wrote and revised the manuscript and figures; Zhang LY contributed to study conception and design, project administration, funding acquisition, revised the manuscript and figures; all of the authors read and approved the final version of the manuscript to be published.
Supported by The Suzhou Medical Center, No. Szlcyxzx202103; The National Natural Science Foundation of China, No. 82171828; The Key R and D Plan of Jiangsu Province (Development of Social), No. BE2021652; The Subject Construction Support Project of The Second Affiliated Hospital of Soochow University, No. XKTJHRC20210011; The Wu Jieping Medical Foundation, No. 320.6750.2021-01-12; The Special Project of "Technological Innovation" Project of CNNC Medical Industry Co. Ltd, No. ZHYLTD2021001; The Suzhou Science and Education Health Project, No. KJXW2021018; Foundation of Chinese Society of Clinical Oncology, No.Y-pierrefabre202102-0113 and No.Y-XD202002/zb-0015; The Beijing Bethune Charitable Foundation, No. STLKY0016; The Research Projects of China Baoyuan Investment Co. Ltd, No. 270004; The Suzhou Gusu Health Talent Program, No. GSWS2022028; The Open Project of State Key Laboratory of Radiation Medicine and Protection of Soochow University, No. GZN1202302; The New Medical Technology Project of the Second Affiliated Hospital of Soochow University, No. 23zl001; The Multi-center Clinical Research Project for Major Diseases in Suzhou, No. DZXYJ202304; The Postgraduate Research and Practice Innovation Program of Jiangsu Province, No. SJCX24_1814; The Gusu Health Talent Research Fund, No. GSWS2022053; The National Natural Science Foundation of China, No. 82102824; and The Scientific Research Program for Young Talents of China National Nuclear Corporation.
Informed consent statement: All study participants provided informed written consent prior to study enrollment.
Conflict-of-interest statement: All authors declare no conflict of interest in publishing the manuscript.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Li-Yuan Zhang, PhD, Chief Physician, Center for Cancer Diagnosis and Treatment, The Second Affiliated Hospital of Soochow University, No. 1055 Sanxiang Road, Suzhou 215000, Jiangsu Province, China. zhangliyuan@suda.edu.cn
Received: April 15, 2024
Revised: September 28, 2024
Accepted: October 22, 2024
Published online: February 24, 2025
Processing time: 240 Days and 1.6 Hours
Abstract
BACKGROUND

Bone is a major site of metastasis in nasopharyngeal carcinoma (NPC). Recently, nuclear factor kappa-beta ligand (RANKL) inhibitors have garnered attention for their ability to inhibit osteoclast formation and bone resorption, as well as their potential to modulate immune functions and thereby enhance the efficacy of programmed cell death protein 1 (PD-1) inhibitor therapy.

CASE SUMMARY

We present a case of a patient with NPC who developed sternal stalk metastasis and multiple bone metastases with soft tissue invasion following radical chemoradiotherapy and targeted therapy. Prior to chemotherapy, the patient experienced severe bone marrow suppression and opted out of further chemotherapy sessions. However, the patient received combination therapy, including RANKL inhibitors (denosumab) alongside PD-1, radiotherapy, and granulocyte-macrophage colony-stimulating factor (PRaG) therapy (NCT05435768), and achieved 16 months of progression-free survival and more than 35 months of overall survival, without encountering any grade 2 or higher treatment-related adverse events.

CONCLUSION

Denosumab combined with PRaG therapy could be a new therapeutic approach for the second-line treatment in patients with bone metastases.

Keywords: Nasopharyngeal carcinoma; Bone metastasis; Radiotherapy; Programmed cell death protein 1 inhibitors; Denosumab; Case report

Core Tip: Bone is a common metastatic site in nasopharyngeal carcinoma (NPC). We report a patient with NPC who developed multiple bone metastases and soft tissue invasion after 1 year of curative chemoradiotherapy and targeted therapy. Due to severe bone marrow suppression from prior chemotherapy, the patient declined further treatment and received denosumab (receptor activating factor ligand inhibitor) combined with PRaG therapy. This regimen resulted in progression-free survival of 16 months and overall survival of more than 35 months, without any grade 2 or higher treatment-related adverse reactions, suggesting a novel therapeutic strategy for patients with refractory NPC.