Patients with recurrent or metastatic nasopharyngeal carcinoma (NPC) who have progressed after platinum-based chemotherapy and immune checkpoint inhibitors face a stark therapeutic landscape—few effective options remain, and outcomes are generally poor. In this heavily pretreated population, conventional chemotherapy yields an objective response rate (ORR) of approximately 30%, with a median progression-free survival (PFS) of only 4–5 months, underscoring a critical unmet clinical need.
Enter veboketamab (brand name Meiyuheng®), an antibody–drug conjugate (ADC) recently approved in China for third-line and beyond treatment of recurrent or metastatic NPC. Veboketamab consists of a humanized anti-epidermal growth factor receptor (EGFR) monoclonal antibody linked via a cleavable linker to monomethyl auristatin E (MMAE), a potent microtubule-disrupting cytotoxic agent. Upon binding to EGFR—overexpressed in up to 89% of advanced NPC tumors—the conjugate is internalized and processed in lysosomes, releasing MMAE intracellularly to induce tumor cell apoptosis and necrosis.
The recommended dosing regimen for veboketamab is 2.3 mg/kg administered as an intravenous infusion every three weeks (21-day cycle), continuing until disease progression or unacceptable toxicity. Intravenous push or rapid bolus injection is strictly contraindicated. Infusions must be delivered over a minimum of 60 minutes—with optimal duration ranging between 60 and 90 minutes—and prepared exclusively by trained healthcare professionals under sterile conditions. Appropriate personal protective equipment and safe handling protocols are mandatory during reconstitution and dilution due to the cytotoxic payload.
Safety monitoring is integral to clinical management. In pooled safety analyses across 465 patients with various solid tumors, 15.9% required dose reductions due to treatment-emergent adverse events. The most common events prompting dose modification (each occurring in ≥1% of patients) included peripheral sensory neuropathy (3.9%), peripheral neuropathy (2.6%), intestinal obstruction (2.2%), myalgia (1.9%), rash (1.7%), fatigue (1.3%), oral mucositis (1.1%), and neutropenia (1.1%). Notably, veboketamab demonstrates a favorable hematologic toxicity profile: grade 3 or higher leukopenia occurred in just 9.3% of patients, markedly lower than the 35.6% incidence observed with standard cytotoxic chemotherapy regimens.
Given its novel mechanism and distinct safety profile, veboketamab represents a meaningful advance for patients with refractory NPC—offering not only improved efficacy but also a more tolerable treatment experience. Rigorous adherence to dosing guidelines, vigilant surveillance for neurologic and gastrointestinal toxicities, and timely, individualized dose adjustments are essential to maximize therapeutic benefit while preserving quality of life.