Reassessing first-line therapy in endemic regions: A meta-analysis on tislelizumab plus chemotherapy for metastatic nasopharyngeal carcinoma

Nasopharyngeal carcinoma (NPC) is a head and neck cancer originating from the nasopharyngeal epithelium. Platinum-based chemotherapy, particularly gemcitabine–cisplatin (GP), remains the standard first-line regimen for recurrent or metastatic NPC (R/M-NPC), despite limited effectiveness. Recent randomized clinical trials (RCTs) have demonstrated that tislelizumab plus chemotherapy (TIGP) significantly improves survival outcomes. However, the high cost of immunotherapy presents financial challenges for patients and healthcare systems.This study systematically evaluated the efficacy, safety, and cost-effectiveness of tislelizumab combined with GP as first-line therapy in R/M-NPC. A systematic search was conducted in PubMed, Scopus, and Cochrane Library up to June 2025. Eligible RCTs compared TIGP with placebo plus GP (PCGP). Meta-analysis wasperformed using a random-effects model, with hazard ratios (HRs) for overall survival (OS), progression-free survival (PFS), and objective response rate (ORR) as primary outcomes. Cost-effectiveness was assessed using incremental cost-utility ratio (ICUR). Three RCTs (JUPITER-02, CAPTAIN-1st, and RATIONALE-309) with 815patients were included. TIGP demonstrated significant benefits in OS (HR=0.60, 95% CI: 0.35–1.00), PFS (HR=0.50, 95% CI: 0.37–0.67), 1-year PFS rate (RR=3.00, 95% CI: 1.84–5.22), and ORR (RR=1.26, 95% CI: 1.04–1.53) compared with PCGP. In conclusion, tislelizumab plus GP offers significant survival and cost-effectivenessadvantages over chemotherapy alone for R/M-NPC patients.