The progression-free survival and overall survival rates seen in patients who required a long duration of corticosteroids while taking anti–PD-1 therapy appear to be worse than in those who did not require corticosteroids, according to the results of a small study.
“Throughout the last few years, the landscape of cancer treatment has evolved significantly with the surge of new immunotherapy approvals and indications for use,” study researchers wrote. “While these agents have shown efficacy and durable responses in a variety of oncologic diseases, their potential to cause immune-related adverse events should not be discounted.”
These adverse events are often treated with systemic steroids. This retrospective study reviewed adult patients who had received at least 4 cycles of an anti–PD-1 therapy for melanoma, non-small cell lung cancer (NSCLC), or renal cell carcinoma (RCC) to see if outcomes differed among patients treated with steroids and those who were not.
About one-half of the patients (27 individuals) required treatment with corticosteroids at some point during treatment with PD-1–targeted checkpoint blockade.
Median time to progression for patients with NSCLC was 5.8 months, for melanoma it was 5.6 months, and for RCC it was 2 months. Of 27 patients, 16 experienced disease progression.
Among patients who had disease progression that required steroids, 5 had received prednisone 10 mg per day or more for 2 weeks or fewer, and 11 received the drug for longer than 2 weeks.
The median overall survival at 2 years was 11.9 months for melanoma, 9.9 months for NSCLC, and not yet reached for RCC. At 2 years, 6 of 27 patients who received steroids had disease that had not progressed, and 14 of these 27 patients were still alive. In comparison, 9 of 28 patients who did not receive steroids had disease that had not progressed, and 20 of the 28 individuals were still alive.
Eighty-five percent of the patients who received prednisone at a dose of 10 mg per day or higher for longer than 2 weeks died during the study period.
“Thus, it would appear that high-dose steroids for long durations are associated with adverse survival outcomes,” the researchers wrote. “However, due to the retrospective nature of this study, there are many confounding factors that make it impossible to establish a causal relationship between the use of steroids during anti-PD1 therapy and survival outcomes.”
Pan EY, Merl MY, Lin K. The impact of corticosteroid use during anti-PD1 treatment [published online September 7, 2019]. J Oncol Pharm Pract. doi: 10.1177/1078155219872786