The use of corticosteroids to treat immune-related adverse events (irAEs) associated with immune checkpoint inhibitor (ICI) therapy was not found to affect overall survival (OS) in patients with non-small cell lung cancer (NSCLC), according to the results of a cohort study published in the European Journal of Cancer.1
High-dose corticosteroids are the standard of care for the treatment of grade 3 to 4 irAEs associated with ICI therapy. Although data from previous studies have suggested that corticosteroids do not affect survival in this setting, most studies have been conducted in patients with melanoma. The aim of this study was to evaluate their effect on survival in a cohort of patients with NSCLC.
The retrospective cohort study included 196 patients with NSCLC without actionable mutations who received treatment with ICI monotherapy or combination therapy between 2016 and 2019 at a single center in Sweden. Corticosteroid dose and duration were considered, as well as the reason for steroid use.
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The median age of the cohort was 70.5 years and 43.8% were male. ICI therapy was administered in the first-line setting for 21.4% of patients, with the remaining 54.1% in the second-line and 25.1% in the third- or subsequent-line. Grade 3 to 4 irAEs developed in 10.7% of patients, including pneumonitis in 3.1%, colitis in 3.6%, and hepatitis in 2.0%.
Corticosteroids were administered at a dose of 10 mg or higher to 46.9% of patients, with reasons including supportive care not associated with cancer-related symptoms or the management of irAEs (13.8%), palliation of symptoms due to the underlying malignancy (17.3%), and the treatment of irAEs (15.8%).
Administration of corticosteroids for irAEs was not found to affect patient outcomes. The median progression-free survival (PFS) was 9.4 months with steroids compared with 4.3 months among patients who were steroid-naïve (P =.308). OS was also similar, with a median of not reached in the steroid group compared with 14.3 months in the steroid-naïve group (P =.380).
Of note, corticosteroid use as palliation for cancer-related symptoms was associated with shorter survival, with a median PFS of 1.9 months and a median OS of 4.3 months. A multivariate analysis confirmed that steroid use for cancer palliation was an independent predictor of shorter PFS (HR, 2.064; 95% CI, 1.291-3.299; P =.002) and OS (HR, 2.688; 95% CI, 1.487-4.856; P =.001).
“Steroid administration due to irAEs does not appear to negatively affect patient outcome,” the study authors concluded. However, they noted that “corticosteroid administration for the palliation of malignancy-related symptoms had an adverse effect on patient outcome.”
Reference
Skribek M, Rounis K, Afshar S, et al. Effect of corticosteroids on the outcome of patients with advanced non–small cell lung cancer treated with immune-checkpoint inhibitors. Eur J Cancer. Published online January 5, 2021. doi:10.1016/j.ejca.2020.12.012
