Corticosteroids represent “the mainstay” for treating ICI irAEs, and “fortunately, the use of corticosteroids in patients with melanoma and NSCLC (and other immune-modulating medications, such as infliximab) in this context have not been found to be associated with decreased efficacy,” the authors explained.1 “Still, it is possible that treatment with corticosteroids immediately before the initiation of PD-1/PD-L1 blockade could distinctly affect efficacy, perhaps by blunting the proliferative burst of CD8-positive T cells needed in response to PD-1/PD-L1 blockade.”

While the overall study population was 640 patients, only 107 of those patients had received corticosteroids at any dose at the time of ICI initiation, the authors cautioned. It was therefore not possible to conduct statistically reliable subgroup analyses to assess the impacts of different steroid doses on ICI outcomes.1

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There might also have been correlation/causation confounds that could not be identified using a retrospective, nonrandomized study design, they added; the association of corticosteroids with ICI-treatment outcomes could have really reflected the prognostic value of patients being prescribed steroids.1 For example, corticosteroid administration might be more common among patients with more aggressive NSCLC and as a result, those patients have higher symptom burdens. Those patients might be expected to have poorer survival outcomes even if corticosteroid administration did not diminish ICI efficacy.

“Ultimately, whether baseline corticosteroids represent correlation or causation, it is clinically relevant for both patients and providers to recognize the effects of corticosteroids on ICI efficacy in patients with NSCLC,” they concluded.1

References

  1. Arbour KC, Mezquita L, Long N, et al. Impact of baseline steroids on efficacy of programmed cell death-1 and programmed death-ligand 1 blockade in patients with non-small-cell lung cancer. J Clin Oncol. 2018;36(28):2872-2878.
  2. Remon J, Besse B, Soria JC. Successes and failures: what did we learn from recent first-line treatment immunotherapy trials in non-small cell lung cancer? BMC. 2017;15:55.
  3. Marshall R, Popple A, Kordbacheh T, Honeychurch J, Faivre-Finn C, Illidge T. Immune checkpoint inhibitors in lung cancer—an unheralded opportunity? Clin Oncol. 2017;29:207-217.
  4. Somasundaram A, Burns TF. The next generation of immunotherapy: keeping lung cancer in check. J Hematol Oncol. 2017;10(1):87.
  5. Horvat TZ, Adel NG, Dung TO, et al. Immune-related adverse events, need for systematic immunosuppression, and effects on survival and time to treatment failure in patients with melanoma treated with ipilimumab at Memorial Sloan Kettering Cancer Center. J Clin Oncol. 2015;33(28):3193-3198.
  6. Scott SC, Pennell NA. Early use of systematic corticosteroids in patients with advanced NSCLC treated with nivolumab. J Thorac Oncol. 2018;13(11):1771-1775.

Topics:

Immunotherapy Lung Cancer