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Les cancers des voies aériennes et digestives supérieures à l’ère de l’immunothérapie : rationnels et spécificités de prise en charge

Respiratory and upper gastrointestinal tract cancers in the immunotherapy era: rationales and specifics of treatment

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Oncologie

Résumé

Les carcinomes épidermoïdes des voies aérodigestives supérieures (VADS) sont fréquents chez l’homme et de pronostic rapidement défavorable en cas de récidive ou d’évolution métastatique. Il existe plusieurs rationnels à l’utilisation de l’immunothérapie dans cette indication. En effet, les tumeurs positives pour des papillomavirus humains sont particulièrement immunogènes et confèrent plusieurs cibles thérapeutiques intéressantes. La vaccination, par analogie avec le cancer du col utérin, pourrait d’ailleurs s’avérer très efficace dans la prévention de survenue de lésions dysplasiques des VADS. Il n’y a actuellement pas de données robustes de vaccination curative. Le développement rapide des immune checkpoints inhibitors dans d’autres localisations tumorales semble enfin émerger dans les cancers des VADS. Des essais sont en cours en concomitance avec la radiochimiothérapie pour des tumeurs localement avancées. Au stade récidivant ou métastatique, les données présentées lors des congrès internationaux sont très en faveur du nivolumab en deuxième ligne, avec une amélioration significative de la survie globale. L’association avec le cetuximab est également à l’étude, bien que la toxicité cutanée semble limitante.

Abstract

Head and neck squamous cell carcinoma (HNSCC) are common for men with a poor prognosis in case of recurrent or metastatic disease. There are several rationales for the use of immunotherapies in this indication. Indeed, human papilloma virus-related cancers are particularly immunogenic and provide many interesting therapeutic targets. The vaccination, as developed in cervical cancer, may be very effective in the prevention of HNSCC dysplasia. There is currently no data for curative vaccination. The rapid immune checkpoints inhibitors development in other cancers seem to arise in HNSCC also. Some trials are recruiting to evaluate anti-PD-1 in association with chemoradiotherapy for advanced tumors. In recurrent or metastatic HNSCC, the results presented in international meetings are overwhelmingly in favor of nivolumab with a significative improvement of overall survival in second line of treatment. The association with cetuximab is also studied but the skin toxicity seems to be limiting.

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Authors and Affiliations

  1. Service d’oncologie–radiothérapie, hôpital de la Pitié-Salpêtrière, F-75013, Paris, France

    C. Gervais

  2. Service d’oncologie médicale, hôpital européen Georges-Pompidou, F-75015, Paris, France

    F. Scotté

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  1. C. Gervais
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  2. F. Scotté
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Correspondence to C. Gervais.

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Gervais, C., Scotté, F. Les cancers des voies aériennes et digestives supérieures à l’ère de l’immunothérapie : rationnels et spécificités de prise en charge. Oncologie 18, 543–550 (2016). https://doi.org/10.1007/s10269-016-2665-x

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  • DOI: https://doi.org/10.1007/s10269-016-2665-x

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