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Does Corticosteroid Use Affect Outcomes With Checkpoint Inhibitors in NSCLC?

By: Sarah Campen, PharmD
Posted: Wednesday, September 18, 2019

In patients with non–small-cell lung cancer (NSCLC) treated with PD-L1 immune checkpoint inhibitors, baseline use of corticosteroids may be associated with poor outcomes. However, research published in the Journal of Clinical Oncology found that this effect seems to be driven by a poor-prognosis subgroup of patients who receive corticosteroids for palliative indications rather than diminished antitumor activity driven by the presence of corticosteroids.

“Our data suggest that corticosteroids should not necessarily be decreased or discontinued before the start of immunotherapy out of a theoretical concern that corticosteroids could impair a response to immunotherapy,” explained Biagio Ricciuti, MD, of Dana-Farber Cancer Institute, Boston, and colleagues.

The researchers retrospectively collected data from 650 patients who were treated with immune checkpoint inhibitors for advanced NSCLC. The patients were divided into three groups: those receiving up to 10 mg of prednisone (n = 557), those receiving at least 10 mg of prednisone for cancer-related palliative indications (n = 66), and those receiving at least 10 mg of prednisone for cancer-unrelated indications (n = 27). Patients who received at least 10 mg of prednisone for cancer-related palliation were more likely to have a poorer Eastern Cooperative Oncology Group (ECOG) performance status (2 or greater; P < .001) and to have brain metastases before the start of immunotherapy (P < .001).

Compared with patients who received up to 10 mg of prednisone, the 93 patients who received at least 10 mg of prednisone at the time of immunotherapy initiation had a shorter median progression-free survival (3.4 vs. 2.0 months) and overall survival (11.2 vs. 4.9 months). However, progression-free and overall survival were significantly shorter only among patients who received prednisone for palliative indications compared with patients who received prednisone for cancer-unrelated reasons and for patients receiving up to 10 mg of prednisone.

Disclosure: The study authors’ disclosure information can be found at ascopubs.org.



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