Expert consensus on the role of immunotherapy in nasopharyngeal carcinoma: clinical and economic perspectives from the GCC region

INTRODUCTION: Nasopharyngeal carcinoma (NPC) is a rare malignancy globally but poses a disproportionate clinical and economic burden in endemic regions, including parts of the Gulf Cooperation Council (GCC). Patients with recurrent or metastatic NPC (RM-NPC) often present with advanced disease and limited therapeutic options, historically relying on platinum-based chemotherapy with modest survival benefit and substantial toxicity. Recent advances in immunotherapy have begun to reshape the treatment landscape. AREAS COVERED: This position paper reviews the evolving role of immunotherapy in RM-NPC, with a particular focus on toripalimab. An advisory board meeting was convened to review disease burden, unmet needs, clinical outcomes associated with immune checkpoint inhibitors, and economic considerations relevant to formulary decision-making. A literature review was conducted from January 2015 to October 2025, focusing on clinical trials, guidelines, and economic evaluations related to immunotherapy in NPC. EXPERT OPINION: Toripalimab in combination with chemotherapy should be adopted as the new standard of care for RM-NPC. Beyond efficacy, its potential value in the GCC extends to health system efficiency and resource allocation. Experts emphasized that value-based assessment frameworks, supported by local, real-world, and economic data, are essential to guide sustainable adoption and equitable patient access to immunotherapy in the region.