Non-Small Cell Lung Cancer Coverage from Every Angle

Does Baseline Steroid Use Impact Efficacy of Immunotherapy in Patients With NSCLC?

By: Sarah Campen, PharmD
Posted: Tuesday, October 2, 2018

A study recently published in the Journal of Clinical Oncology found that baseline treatment with corticosteroids was associated with poorer outcome in patients with non–small cell lung cancer (NSCLC) who were treated with PD-1 or PD-L1 inhibitors. Clinical trials investigating this class of medication typically do not include patients who have received baseline corticosteroids, which led Kathryn C. Arbour, MD, of Memorial Sloan Kettering Cancer Center, New York, and colleagues to use “real-world” data to examine the effect of corticosteroids at treatment initiation.

“Prudent use of corticosteroids at the time of initiating [PD-1/PD-L1] blockade is warranted,” cautioned Dr. Arbour and colleagues.

The researchers identified 640 PD-L1–naive patients with advanced NSCLC who were treated with single-agent PD-L1 blockade. Of them, 90 (14%) received corticosteroids of ≥ 10 mg of prednisone equivalent daily at the initiation of treatment with immunotherapy, most often for dyspnea (33%), fatigue (21%), and brain metastases (19%).

In 2 independent cohorts, Memorial Sloan Kettering Cancer Center (n = 455) and Gustave Roussy Cancer Center (n = 185), baseline corticosteroids were associated with a decreased overall response rate, progression-free survival, and overall survival with PD-L1 blockade. After adjusting for variables, progression-free survival (P = .03) and overall survival (P < .001) remained significantly associated with baseline corticosteroid use.

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