Risk-Adapted Anlotinib and PD-L1 for Locoregionally Advanced Nasopharyngeal Carcinoma

The purpose of this study is to evaluate the efficacy and safety of a risk-adapted treatment strategy incorporating induction therapy (Gemcitabine + Cisplatin) with Anlotinib plus Benmelstobart, followed by treatment allocation based on post-induction plasma cell-free Epstein-Barr virus DNA (cfEBV DNA) status and radiographic response in patients with locoregionally advanced nasopharyngeal carcinoma. All participants will receive three cycles of induction therapy (Gemcitabine + Cisplatin) with Anlotinib plus Benmelstobart. After induction therapy, participants with cfEBV DNA clearance and a complete or partial response will be classified as low risk and receive intensity-modulated radiotherapy alone, followed by adjuvant Benmelstobart. Participants without cfEBV DNA clearance or with stable or progressive disease will be classified as high risk and receive intensity-modulated radiotherapy with concurrent cisplatin, followed by adjuvant Benmelstobart and capecitabine. The primary objectives are to evaluate the post-induction therapy complete response rate in the overall study population and event-free survival in the high-risk group.