CISPLATIN IS A CORNERSTONE of treatment for people with nasopharyngeal cancer that has spread beyond the upper throat, but this type of chemotherapy carries debilitating side effects.

“Whenever you can, avoid cisplatin,” says Chukwuemeka Ikpeazu, a thoracic/head and neck medical oncologist at the University of Miami Sylvester Comprehensive Cancer Center in Florida. “It’s one chemotherapy that causes the most significant nausea and vomiting.”

People who take the immunotherapy Loqtorzi (toripalimab) may be able to forgo rounds of cisplatin toward the end of their treatment, according to research published Aug. 21, 2025, in JAMA.

The study included 532 people with newly diagnosed nasopharyngeal cancer that was locoregionally advanced, meaning it had spread to nearby tissues or lymph nodes but not to distant parts of the body. All patients were treated with Loqtorzi and administered chemotherapy with cisplatin and gemcitabine. However, half of patients then received radiation with cisplatin, while the other half received radiation alone. The three-year failure-free survival rates, defined as the percentage of people who did not have a recurrence, were 88.3% for people who were spared cisplatin during radiation and 87.6% for those who received standard treatment.

“These results suggest that removing concurrent cisplatin [with radiation], while using full-course immunotherapy, does not compromise long-term survival outcomes,” says study co-author Jun Ma, a radiation oncologist and the executive vice president of the Sun Yat-sen University Cancer Center in China, in an email.

In addition, 26.2% of people who didn’t receive cisplatin with radiation experienced vomiting, compared with 59.8% of those in the standard treatment group. People who were spared the extra cisplatin also reported better quality of life.

Such “de-intensified” treatment of nasopharyngeal cancer is a promising approach for doctors and patients, achieving similar survival to current treatment but with less toxic side effects, Ma says. His team is now studying the safety and efficacy of another immunotherapy called cadonilimab at different points throughout treatment. Ma also anticipates that in future clinical trials, patients may be treated with immunotherapy for six months, a reduction from the current duration of nine to 12 months.

The Food and Drug Administration approved Loqtorzi, in combination with cisplatin and gemcitabine, as a first-line treatment in people with metastatic or recurrent locally advanced nasopharyngeal cancer in 2023. The immunotherapy isn’t approved as part of a treatment regimen in newly diagnosed patients with localized disease, says John Deeken, a medical oncologist and president of the Inova Schar Cancer Institute in Fairfax, Virginia. However, more than 70% of nasopharyngeal cancers are diagnosed after the disease has spread to nearby tissues or lymph nodes.

“Immunotherapy is revolutionizing how we treat many cell tumors,” says Deeken, who wasn’t involved in the research. “We’re continuing to improve how we treat [nasopharyngeal] cancer and figure out what the role of immunotherapy is in what setting and to improve our cure rate for patients.”

Nasopharyngeal cancer is rare throughout much of the world, with less than one case occurring annually per 100,000 people in the U.S., according to the American Cancer Society. But it’s more common in parts of South Asia, North Africa and the Middle East and among Native people in the Arctic. In China, where the trial was conducted, there are up to 20 cases per 100,000 women and 30 per 100,000 men.

Nasopharyngeal cancer in China is often a type related to infection with the Epstein-Barr virus, and participants in the trial had this cancer type. But the study noted that cases in the U.S. are mostly of another type, and further research should be done to understand how Loqtorzi treatment might apply to other populations.

Moreover, further follow-up is needed to test whether limiting cisplatin use in this way has long-term effects on factors such as hearing and cognition, Ma says.

For Ikpeazu, who wasn’t involved in the study, such expanded immunotherapy options deserve continued attention. “Nasopharyngeal carcinomas have for a long time been ignored when it comes to the standard clinical trials for head and neck cancer.”