1. Chimiothérapie d'induction
1.1. Intérêt de l'induction ou RTCT d'emblée ?
- PARADIGM (2004-2008 . essai arrêté par défaut d'inclusion)
- TPF puis RTCetux vs RTCT(CarboFu) (Gortec 2007-02 T2-T4 N2b palpable-N2C-N3)
- DECIDE, ( essai arrêté précocement par défaut d'inclusion)
The issue of induction chemotherapy (ICT) interest in locoregionally advanced squamous cell cancer of the head and neck is a real epic that has been carried out over four phase III studies: PARADIGM, DECIDE, NCT01086826 and lastly the conclusive GORTEC 2007-02. With no significant benefit in overall survival of ICT, followed by concurrent chemoradiation over the standard chemoradiotherapy alone, in three of these studies, and a significant number of treatment-related deaths with the standard regimen docetaxel, cisplatin, and fluorouracil, ICT is no longer a hot topic. However, this strategy might still be useful in the aim of limiting the metastatic extension affecting up to 30% of patients: ICT is systematically associated with a reduced metastatic relapse even though the survival effect is never statistically significant when compared directly with concomitant radiochemotherapy. (1)
1.2. Quel type d'induction ?
- TAX 323
- TAX 324 (PF vs TPF Etude Posner)
- PICH (Gortec: TPF vs TPF - pembrolizumab - phase II ouverte)
1.3. Préservation d'organe (larynx/ hypopharynx)
- EORTC 24891: (Kcer hypopharynx)
- TREMPLIN: (Gortec 2005-01)
- SALTORL: (Gortec 2014-03 TPF puis RT vs RTCT)
2. RTCT concomitante
2.1 avec sels de platine
- RT vs RT-CDDP
* EORTC 22 931 ?
* RTOG 9501 ?
- comparaison association Carbo/Fu - CDDP
- CisFrad (Gortec RT avec CCDP hebdo s1 s4 s7 vs J1 J22 J43)
2.2. avec Erbitux
- Etudes du Memorial Sloan-Kettering Cancer Center
- RT-Cetux vs RT-Cetux-CT (Gortec 2007-01 T1-T4 N0-N2a (N2b non palpable)) augmentation PFS mais toxicité
2.3 avec immunothérapie
- inhibiteur IAP (phase II Gortec)
- REACH (Gortec 2017-01: évaluation de l'adjonction d'avelumab à la RTCT ou RT-CEtux)
- REWRITe (Gortec 2018-02: essai Phase II radiothérapie-durvalumab sans irradiation prophylactique)
2.4 avec nanoparticules
4. Cancers récidivants ou métastatiques des VADS
4.1 1ère ligne
- Extreme
- TPEx vs Extreme (ASCO 2019)
- Keynote 048 (ASCO 2019 pembrolizumab)
- nivolumab et l'ipilimumab vs EXTREME (essai phase III - clôture 17/02/2019)
- FRAILIMMUNE (GORTEC 2018-03: étude de phase II, monobras, Durvalumab-Carboplatine-Paclitaxel, pour patients non éligibles à la chimiothérapie standard)
4.2 2ième ligne
The anti-PD1 antibodies nivolumab and pembrolizumab were superior to investigators' choice chemotherapy
