Impact of corticosteroids and antibiotics on efficacy of immune-checkpoint inhibitors in advanced non-small cell lung cancer

Martinez, J. Mosquera; Riuvadets, M.; Campelo, M.R. García; López, José Antonio González; Anguera, Geòrgia; Melo, P. Gallardo; Sullivan, Ivana; Joaquín, A. Barba; Tarruella, M. Majem; Rendo, C. Reboredo; González, Patricia Cordeiro

doi:10.1093/annonc/mdz253.117

Cited by 4 publications

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“…Numerous subsequent reports, which were published as abstracts in several congresses, appear to be aligned with the above-mentioned evidence, overall showing a detrimental effect of a concomitant use of steroids at baseline on CPIs' efficacy and patients' survival (Table 1) (35)(36)(37)(38).…”

Section: Clinical Evidencesmentioning

confidence: 71%

Exploring the immune-checkpoint inhibitors’ efficacy/tolerability in special non-small cell lung cancer (NSCLC) populations: focus on steroids and autoimmune disease

Passiglia¹,

Cetoretta²,

Filippis³

et al. 2021

Transl Lung Cancer Res

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The advent of immune-checkpoint inhibitors targeting the programmed cell death-1 (PD-1)/ programmed death ligand-1 (PD-L1) axis, both as monotherapy and in combination strategies, produced a paradigm change of the treatment algorithm for metastatic, non-oncogene addicted, non-small cell lung cancer (NSCLC) patients. Although the great efficacy and the optimal tolerability emerging from clinical studies has been confirmed for the majority of patients treated in the real-word scenario, however the potential activity and safety profile of these agents in uncommon NSCLC populations remains still controversial. Particularly, patients with previously diagnosed autoimmune disease or concomitant steroids treatment at the time of immunotherapy initiation represent two special subgroups of patients not unusual in the real-word practice, to whom the clinical implication of immune-checkpoint inhibitors administration is largely unknown. In this review we provided an updated literature overview, summarizing available evidence and reporting practical suggestions, which may guide physicians in their clinical management of these NSCLC sub-populations.

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Section: Clinical Evidencesmentioning

confidence: 71%

Exploring the immune-checkpoint inhibitors’ efficacy/tolerability in special non-small cell lung cancer (NSCLC) populations: focus on steroids and autoimmune disease

Passiglia¹,

Cetoretta²,

Filippis³

et al. 2021

Transl Lung Cancer Res

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“…6,7 Several retrospective studies assessed the effect of baseline corticosteroid on immunotherapy efficacy in patients with advanced cancer. [8][9][10][11][12][13][14] Results from these studies were conflicting. Notably, 2 recent studies suggested that a baseline prednisone-equivalent of ≥ 10 mg within 30 days of immunotherapy initiation was associated with decreased treatment efficacy in patients with non-small cell lung cancer (NSCLC).…”

mentioning

confidence: 99%

“…8,9 A subsequent study suggested similar overall findings but attributed the decreased treatment efficacy to a poor-prognosis subgroup as indicated by palliative-intent corticosteroid use. 10 Moreover, these studies were mainly completed in patients with advanced NSCLC [8][9][10][11][12][13] and genitourinary cancers, 11,14 and only 1 study involved patients with advanced melanoma. 11 The largest study involved 742 patients with advanced melanoma on any line of immunotherapy, with 182 of them received baseline corticosteroid ≤ 14 days prior and up to 30 days after immunotherapy initiation.…”

mentioning

confidence: 99%

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Impact of Baseline Corticosteroids on Immunotherapy Efficacy in Patients With Advanced Melanoma

Kartolo¹,

Deluce

Holstead³

et al. 2021

Journal of Immunotherapy

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This is a 2-center, retrospective study which aimed to evaluate the effect of baseline corticosteroid use on immunotherapy efficacy in patients with advanced melanoma. We included all patients with advanced unresectable and metastatic melanoma on single-agent programmed cell death protein 1 (PD-1) inhibitors at the Cancer Centre of Southeastern Ontario and London Regional Cancer Program. We defined baseline corticosteroid use as prednisone-equivalent of ≥ 10 mg within 30 days of immunotherapy initiation. Our study had 166 patients in total, and 25 were taking corticosteroids at the initiation of the PD-1 inhibitor. Baseline prednisone-equivalent ≥ 10 mg did not have effect on median overall survival (hazard ratio = 1.590, 95% confidence interval: 0.773-3.270, P = 0.208). However, a higher dose of baseline prednisone-equivalent ≥ 50 mg was independently associated with poor median overall survival (hazard ratio = 2.313, 95% confidence interval: 1.103-4.830, P = 0.026) when compared with baseline prednisoneequivalent 0-49 mg, even when controlled for confounders including baseline Eastern Cooperative Oncology Group ≥ 2 and baseline brain metastasis. Consideration should be made to decrease the use of unnecessary steroids as much as possible before initiation of PD-1 inhibitor treatment.

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Do corticosteroids affect immunotherapy efficacy in malignancy? – A systematic review

Byron,

Yegorova‐Lee,

Tio

2024

Cancer Medicine

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BackgroundEarly studies indicated that corticosteroids may limit the survival benefit from immunotherapy. We conducted this systematic review to evaluate the effect corticosteroids have on immunotherapy in patients with malignancy, when adjusted for potentially confounding effects of corticosteroids given for palliative indications.MethodsThree electronic databases (PubMed, Embase and Medline) were searched on 1 February 2023. Studies that measured response or survival to immunotherapy in people receiving corticosteroids for non‐cancer indications compared to either no corticosteroids or corticosteroids for cancer‐related indications were included. Studies exclusively evaluating the effect of corticosteroids administered for immune‐related adverse events (irAE) were excluded to avoid immortal time bias. Pooled odds and hazard ratios with 95% confidence intervals (CI) were calculated using a random effects model. Study heterogeneity was assessed using the I2 statistic, and publication bias was evaluated by funnel plot and Egger's regression model.ResultsEight thousand four hundred and twenty‐six titles were identified on our search. Eight studies met our inclusion criteria for meta‐analysis. Administration of corticosteroids does not have a statistically significant effect on survival and response to immunotherapy when administered for non‐cancer‐related indications, with a pooled odds ratio for overall response rate 1.01 (95% CI 0.64–1.60); pooled hazard ratio (HR) for progression free survival 0.87 (95% CI 0.68–1.12); and pooled HR for overall survival 0.79 (95% CI 0.59–1.05).ConclusionThis systematic review indicates that administration of corticosteroids does not affect response to immunotherapy nor survival outcomes, when removing confounding palliative corticosteroid indications. These results are limited by the retrospective nature of the studies included, small sample sizes, lack of information about corticosteroid dosing and the inclusion of irAE in two of the studies which could bias the results.

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Impact of corticosteroids and antibiotics on efficacy of immune-checkpoint inhibitors in advanced non-small cell lung cancer

Cited by 4 publications

References 0 publications

Exploring the immune-checkpoint inhibitors’ efficacy/tolerability in special non-small cell lung cancer (NSCLC) populations: focus on steroids and autoimmune disease

Exploring the immune-checkpoint inhibitors’ efficacy/tolerability in special non-small cell lung cancer (NSCLC) populations: focus on steroids and autoimmune disease

Impact of Baseline Corticosteroids on Immunotherapy Efficacy in Patients With Advanced Melanoma

Do corticosteroids affect immunotherapy efficacy in malignancy? – A systematic review

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