Effect of corticosteroids on the outcome of patients with advanced non-small cell lung cancer treated with immune-checkpoint inhibitors
Menée en Suède à partir de données portant sur 196 patients atteints d'un cancer du poumon non à petites cellules de stade avancé recevant des inhibiteurs de points de contrôle immunitaire, cette étude rétrospective analyse l'effet, sur la survie globale et sur la survenue d'événements indésirables induits par les traitements anticancéreux, d'une utilisation de corticoïdes (prednisolone)
Introduction : We analysed patients with advanced non–small cell lung cancer (NSCLC) who were treatedwith immune-checkpoint inhibitors (ICIs) to address the effect of the timeline andreason for corticosteroid administration on survival outcomes.
Methods : We retrospectively collected clinical data of non-oncogenic driven, advanced NSCLCpatients treated with ICIs at Karolinska University Hospital, including the timelineand reason for steroid administration. Steroid administration was defined as > 10 mg prednisolone equivalent for ≥10 days. We subcategorized patients based on the aetiologyof steroid administration into three subgroups: a) steroids for supportive reasonsbut not for cancer palliation; b) steroids for the palliation of cancer-related symptoms;c) steroids for the management of immune-related adverse events (irAEs). Furthermore,to analyse the timeline, patients were categorised into two groups; those who receivedcorticosteroids within 2 weeks before until 2 days after ICI initiation and thosewho received steroids later during their treatment course.
Results : Analysed data from 196 patients showed 46.3% of patients received corticosteroids.Steroid administration due to irAEs did not affect overall survival (OS) (p = 0.38)compared with the steroid naïve group. Only steroid administration for the palliation of cancer-related symptoms was an independent predictor for shorter OS (HR = 2.7;95% CI, 1.5–4.9). The timeline of steroid administration did not affect OS (p = 0.456)in our cohort.
Conclusions : Steroids due to irAEs do not appear to hamper ICI efficacy. However, the administrationof high-dose steroids to palliate malignancy-associated symptoms might reflect thedismal prognosis of this patient group.
European Journal of Cancer , résumé, 2020