Adjuvant or neoadjuvant treatment with immune checkpoint inhibitors: re-assessing the risk-benefit ratio
A partir d'une revue systématique de la littérature (28 essais randomisés, 16 976 patients), cette méta-analyse évalue la toxicité de l'ajout d'inhibiteurs de points de contrôle immunitaire à un traitement péropératoire chez des patients atteints d'une tumeur solide
In 2012, the first immune checkpoint inhibitor targeting CTLA-4, ipilimumab, received approval for the treatment of metastatic melanoma. Shortly thereafter, PD-1 inhibitors followed suit, and both treatments rapidly established themselves as the standard of care not only for metastatic melanoma but also for various other cancers. Long-term remissions and even potential cure became attainable for patients with metastatic cancers treated with immune checkpoint inhibitors. However, this substantial improvement in survival came with a potential downside in terms of toxicity, because some patients had treatment-related adverse events, some of which might be irreversible or, in a small proportion of cases, fatal. However, the risk–benefit ratio remained in favour of the use of immune checkpoint inhibitors considering their major benefit in the advanced setting. Immune checkpoint inhibitors were used as earlier cancer therapies, including in the adjuvant and neoadjuvant setting. Treatment with PD-1 inhibitors was shown to reduce the risk of relapse by 45% in stage III melanoma, and was quickly followed by studies highlighting the benefit of neoadjuvant treatment. 1 , 2 Then, the benefit–risk ratio of immune checkpoint inhibitors had to be reassessed at these earlier cancer stages, because patients could be cured with surgery or radiotherapy alone.
The Lancet Oncology , commentaire, 2022