Immunotherapeutics in nasopharyngeal carcinoma: a relentless CONTINUUM of success
Mené sur 425 patients atteints d'un carcinome rhinopharyngé (durée médiane de suivi : 41,9 mois), cet essai randomisé multicentrique de phase III évalue l'efficacité, du point de vue de la survie sans événement, d'un ajout de sintilimab à une chimioradiothérapie standard
Nasopharyngeal carcinoma is a subset of head and neck cancers characterised by association with the Epstein–Barr virus and a distinct tumour immune microenvironment. The observed increase in expression of effector and exhaustion markers, including PD-1 and CTLA4, on tumour infiltrating lymphocytes support the use of immune checkpoint inhibitors in this disease. In the past 3 years, we have witnessed the rapid pace of incorporating anti-PD-1 antibodies into the treatment regimens of patients with metastatic nasopharyngeal carcinoma with likely practice changing results from three randomised phase 3 trials (JUPITER-02, CAPTAIN1, and RATIONALE-309) that added PD-1 inhibitors to standard gemcitabine and cisplatin for patients with recurrent metastatic disease. All three studies showed a significant improvement in progression-free survival with a manageable safety profile favouring the anti-PD-1 group. These results were solidified in 2023 by the overall survival advantage shown in JUPITER-02 and the US Food and Drug Administration approval of toripalimab. These transforming trials were reported following or contemporaneously with other phase 3 trials confirming the value of intensification with systemic agents in patients with locally advanced nasopharyngeal carcinoma either by using a sequential design 6 or with maintenance metronomic chemotherapy.