A subgroup analysis revealed that non-small cell lung cancer (NSCLC) patients treated with immune checkpoint inhibitors had worse clinical outcomes if they received corticosteroids at baseline for palliative indications compared with nonpalliative indications. The subgroup analysis, as well as the full study analysis, was published online June 17, 2019, in the Journal of Clinical Oncology.1

The study analysis included 650 patients with advanced NSCLC who received a programmed cell death-1 (PD-1) or programmed death ligand-1 (PD-L1) inhibitor alone or in combination with a cytotoxic T-cell lymphocyte associated protein 4 (CTLA-4) inhibitor at Dana-Farber Cancer Institute, Boston, Massachusetts.

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Patients were divided into two groups, those who received 0 mg to less than 10 mg of prednisone (557 patients) and those who received at least 10 mg of prednisone and were therefore considered recipients of corticosteroids (93 patients). A retrospective review of patients charts revealed the reasons patients received corticosteroids, leading to the labeling of patients as receiving corticosteroids for either cancer-related palliative indications (66 patients) or cancer-unrelated nonpalliative indications (27 patients).

Overall, the receipt of at least 10 mg of prednisone at baseline was associated with worse overall response rate (ORR), median progression-free survival (mPFS), and median overall survival (mOS) compared with the receipt of 0 mg to less than 10 mg of prednisone.


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However, a subgroup analysis revealed that patients who received at least 10 mg prednisone for palliative indications has significantly lower ORR, shorter mPFS, and shorter mOS compared with patients who received at least 10 mg of prednisone for nonpalliative indications and compared with patients who received 0 to less than 10 mg of prednisone. No difference in clinical outcomes were seen for patients who received at least 10 mg of prednisone for nonpalliative indications compared with patients who received 0 to less than 10 mg of prednisone.

“These data suggest that the significantly worse outcomes among patients who receive corticosteroids before immunotherapy are driven by the group of patients treated with corticosteroids for palliative oncologic symptom management, rather than by patients receiving corticosteroids for other reasons,” the study authors wrote.

Disclosure: Some of the authors of the original study reported having financial ties to health care/pharmaceutical companies. For a complete list of disclosures, please refer to the original study.

Reference

Ricciuti B, Dahlberg SE, Adeni A, et al. Immune checkpoint inhibitor outcomes for patients with non-small-cell lung cancer receiving baseline corticosteroids for palliative versus nonpalliative indications. J Clin Oncol. doi: 10.1200/JCO.19.00189