CAPA followed by radiotherapy achieved high response rates and promising survival outcomes in patients with early-stage extranodal natural killer/T-cell lymphoma (NKTCL), according to a multicentre Phase 2 trial. The chemotherapy-sparing approach was also associated with relatively low rates of severe haematological toxicity, addressing a challenge associated with conventional asparaginase-based chemoradiotherapy.
The trial investigated whether induction treatment with camrelizumab, low-dose apatinib, and pegaspargase (CAPA), followed by sequential radiotherapy, could provide effective disease control while reducing blood-related complications.
Adults with biopsy-confirmed nasal or upper aerodigestive tract NKTCL at Lugano Stage I or II received four 21-day cycles of CAPA, followed by intensity-modulated radiotherapy at a dose of 50–56 Gy. The primary endpoint was complete response at week 24, assessed using Lugano 2014 criteria.
Between June 2020 and October 2022, 61 patients received CAPA. Of these, 54 (88.5%) had evaluable assessments at week 24.
At week 24, 88.9% of evaluable patients (48/54) achieved a complete response, while the overall response rate was 92.6%. After a median follow-up of 42.2 months, the estimated 2-year progression-free survival rate was 83.3%, and overall survival was 88.9%.
Grade 3–4 treatment-emergent adverse events occurred in 29 patients (47.5%). The most frequently reported were hypertriglyceridaemia (19.7%) and hypertension (11.5%). Grade 3-4 neutropenia occurred in two patients (3.3%), while one patient (1.6%) experienced anaemia. No treatment-related deaths were reported.
Exploratory analyses indicated that patients who had not responded by week 12, or who did not achieve sustained clearance of Epstein–Barr virus (EBV) DNA, were more likely to experience inferior survival outcomes. These findings suggest that early treatment response and EBV DNA clearance could help identify patients with less favourable outcomes.
Overall, the results support further investigation of the CAPA regimen followed by radiotherapy as a chemotherapy-sparing option for early-stage NKTCL. However, the trial was single-arm and included 61 patients, meaning that larger comparative studies will be needed to establish its effectiveness and safety relative to existing treatment approaches.
Reference
Liu C et al. CAPA induction followed by sequential radiotherapy for newly diagnosed stage I/II extranodal NK/T-cell lymphoma: a multicentre, single-arm, phase 2 trial. Blood Cancer J. 2026; DO:Ihttps://doi.org/10.1038/s41408-026-01623-7.
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