It took twenty years. Two decades during which patients with ENT cancer at an advanced stage were offered identical treatment, with disappointing results. At ASCO 2025, a new hope was born: immunotherapy could finally tip over the forecasts. In sight: nivolumab, a molecule capable of reducing the risk of relapse after an operation. The International Nivopostop study, presented from the ASCO Congress in Chicago, relies on 680 patients with locally advanced and operated cancer. Objective: to assess whether the addition of nivolumab to conventional chemoradiotherapy could improve survival without relapse.
Two decades of failure, and finally a credible track for ENT cancers
Each year, head and neck cancer are among the most feared: they represent the 6th cancer most diagnosed in the world, more than 11,000 people in France. The majority of these cancers (90%) are ENT epidermoid carcinomas, cancers related to tobacco, alcohol or human papillomavirus, arising in the mucous memblosses of the mouth, pharynx or even larynx. In the majority of cases, patients are diagnosed at a so -called “locally advanced” stage. Standard treatment is based on heavy surgery, followed by a chemotherapy/radiotherapy association (called chemoradiotherapy) in post-operative. But even when they are operable, some of these cancers have a high risk of relapse after surgery.
But the figures have not evolved for years. “”Results for patients with locally advanced ENT cancer are generally bad, with only 50 to 55 % of patients without sickness three years after standard treatment “declares Jean Bourhis, principal researcher of the study, of the Lausanne University Hospital. He adds: “We have been trying for more than 20 years to improve this care“.
The latest advances in the treatment of this disease, which included the addition of cisplatin to post-surgical radiotherapy, go back to more than two decades. The rate of relapse in high -risk patients remains high, with about half of them facing a recurrence. And at this stage, the therapeutic options remain limited, which highlights the urgent need for more effective treatments. Although many trials have been carried out in recent years, especially with EGFR inhibitors, none has yet brought sufficient evidence to improve the prognosis of patients. But an announcement made at the ASCO congress resonated like an electroshococ.
Nivolumab, immunotherapy that reverses the tendency of relapses
The nivopostop clinical trial protocol is precise: patients, all under the age of 75, were divided into two groups. The first received standard chemoradiotherapy. The second, in addition to this chemotherapy, received nivolumab, a monoclonal antibody already used in other cancers (10 cures spread over eight months: two weeks before and during radio-chemotherapy, then six months of maintenance treatment).
The results are clear: at three years of follow -up, 63.1 % of patients who received the Nivolumab had not relapsed, against 52.5 % in the standard group. This corresponds to an improvement of 24 % of the chances of survival without recurrence.
For Dr. Yungan Tao, this data is a first: “This is the first major advance in this clinical situation for more than two decades“.
Note, however, that this approach is not without risks. Patients treated with nivolumab have presented more severe side effects: 13.1 % experienced undesirable grade 4 (compared to 5.6 % for chemoradiotherapy alone). Effects in particular linked to a severe drop in white blood cells.
Towards a new standard to treat advanced forms?
Despite these side effects, the enthusiasm of the experts is palpable. The benefit in terms of disease -free survival seems robust enough to modify the care in the years to come. Dr. Glenn J. Hanna, director of the Center for Cancer Therapeutic Innovation at Dana-Farber Cancer Institute, summarizes the importance of this advance:
“”The addition of nivolumab to chemoradiotherapy in high-risk ENT cancers has improved survival without illness, regardless of the PD-L1 status of the tumor. This is the first study to show this benefit “. He recalled that other studies using another immunotherapy (Pembrolizumab) had recently obtained good results administered before and after surgery: “”From now on, the question is how to best articulate the different immunotherapies in this type of cancer“.
The prospect of more effective treatment, after years of stagnation, could reduce the therapeutic options in ENT cancerology in depth. And for thousands of patients, this could well mean better management.