Elsevier

European Journal of Cancer

Volume 145, March 2021, Pages 245-254
European Journal of Cancer

Original Research
Effect of corticosteroids on the outcome of patients with advanced non–small cell lung cancer treated with immune-checkpoint inhibitors

https://doi.org/10.1016/j.ejca.2020.12.012Get rights and content
Under a Creative Commons license
open access

Highlights

  • Steroid administration for cancer palliation was linked with poor patient outcomes.

  • Steroid administration due to immune-related adverse events did not affect patient survival outcomes.

  • Careful patient selection is warranted before immunotherapy initiation.

Abstract

Introduction

We analysed patients with advanced non–small cell lung cancer (NSCLC) who were treated with immune-checkpoint inhibitors (ICIs) to address the effect of the timeline and reason for corticosteroid administration on survival outcomes.

Methods

We retrospectively collected clinical data of non-oncogenic driven, advanced NSCLC patients treated with ICIs at Karolinska University Hospital, including the timeline and reason for steroid administration. Steroid administration was defined as > 10 mg prednisolone equivalent for ≥10 days. We subcategorized patients based on the aetiology of steroid administration into three subgroups: a) steroids for supportive reasons but not for cancer palliation; b) steroids for the palliation of cancer-related symptoms; c) steroids for the management of immune-related adverse events (irAEs). Furthermore, to analyse the timeline, patients were categorised into two groups; those who received corticosteroids within 2 weeks before until 2 days after ICI initiation and those who received steroids later during their treatment course.

Results

Analysed data from 196 patients showed 46.3% of patients received corticosteroids. Steroid administration due to irAEs did not affect overall survival (OS) (p = 0.38) compared with the steroid naïve group. Only steroid administration for the palliation of cancer-related symptoms was an independent predictor for shorter OS (HR = 2.7; 95% CI, 1.5–4.9). The timeline of steroid administration did not affect OS (p = 0.456) in our cohort.

Conclusions

Steroids due to irAEs do not appear to hamper ICI efficacy. However, the administration of high-dose steroids to palliate malignancy-associated symptoms might reflect the dismal prognosis of this patient group.

Keywords

Non–small cell lung cancer
Immunotherapy
Immune-checkpoint inhibitors
Corticosteroids
Immune-related adverse events

Cited by (0)

1

Equal contribution.