Immunotherapy in Prepatients—Preventing or Promoting a Malignant Transformation?
Mené sur 33 patients atteints d'une leucoplasie verruqueuse proliférative à haut risque de transformation en un carcinome épidermoïde invasif de la cavité buccale (âge médian : 63 ans ; durée médiane de suivi : 21,1 mois), cet essai non randomisé de phase II évalue l'efficacité, du point de vue du changement de taille et de dégré de la dysplasie mesuré par un système de score, et la toxicité du nivolumab
Immune checkpoint inhibitors (ICIs) have improved outcomes in the treatment of several metastatic cancers and are increasingly being evaluated in earlier lines of treatment as adjuvant and neoadjuvant therapies. In early-stage disease, ICIs have received several new approvals, usually without evidence of overall survival benefit. Naturally, researchers and drugmakers will question whether ICIs have a role even earlier in the course of disease, perhaps as a cancer prevention strategy. The natural place to begin such a quest would be in a premalignant condition where (1) the population’s probability of malignant transformation is high, (2) the agent has activity against the ensuing cancer, and (3) standard of care for the ensuing cancer is ineffective or unacceptably toxic. These criteria being met, it is reasonable to ask whether administering anticancer therapies to people lacking a cancer diagnosis reduces cancer incidence, enhances quality of life for those with the premalignant condition, offers benefit that outweigh risks, reduces mortality, and is cost-effective.
JAMA Oncology , commentaire, 2022