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Introduction: We analysed patients with advanced nonesmall 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 Z 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 Z 2.7; 95% CI, 1.5e4.9). The timeline of steroid administration did not affect OS (p Z 0.456) in our cohort.

Caloric restriction in animals is an effective way to reduce carcinogenesis. Anorexia nervosa (AN) is considered a model of extreme caloric restriction in humans. The aim of our study was to assess cancer incidence and mortality in women with AN. A total of 6,009 women with at least one inpatient treatment for AN during the period 1973-2003 were included in the study. Standardized incidence ratios (SIR) and standardized mortality ratios (SMR) were calculated. Overall, there was no statistically significant difference in cancer incidence compared to women in the general population. At a statistically significant or borderline significant level, a higher incidence for lung cancer and cancer of lymphoid, hematopoietic and related tissue was observed along with a reduced breast cancer incidence. Women with AN had twice as high mortality from cancer in general, and more specifically from melanoma, cancers of genital organs and cancers of ill-defined, secondary and unspecified sites. The increased lung cancer incidence may be due to smoking habits among women with AN. The worse prognosis with higher mortality from melanoma, cancers of genital organs and cancers of ill-defined, secondary and unspecified sites may be explained by AN-specific attitudes toward seeking medical care, adherence to treatment or worse biological precondition due to starvation and cachexia.There is substantial evidence that excess body weight is a risk factor for a variety of malignancies in humans, including cancer of the colon, 1 liver, 2 gallbladder, 3 pancreas, 4 breast in postmenopausal women, prostate, endometrium, 5 ovaries, 6 kidney, 7 esophagus 7 and hematological cancers. 8,9 The underlying mechanisms are still not fully understood, but the role of correlates such as physical inactivity, visceral adiposity, hyperglycemia and hyperinsulinemia have been the object for intense research.Moreover, a restriction in caloric intake, which does not however lead to malnutrition, is one of the most effective ways to extend lifespan and reduce spontaneous as well as induced carcinogenesis in rodents 10-13 and primates. 14,15 Various mechanisms have been proposed in order to explain this finding, including decreased cell proliferation, reduced oxidative damage to DNA, increased DNA repair as well as modulation of oncogenes and tumor suppressor genes. 10,12,13 In humans, the evidence that caloric restriction has a protective effect against carcinogenesis is less robust. Epidemiological studies from Norway and the Netherlands on the effects of severe undernutrition in adolescence during the Second World War on subsequent cancer occurrence have been inconclusive. [16][17][18] Anorexia nervosa (AN) is a mental health disorder characterized by very low caloric intake, low body mass index (BMI) and amenorrhea. AN occurs most commonly in adolescent girls and young women and is associated with a specific disturbance of body image whereby a dread of gaining weight persists as an intrusive overvalued idea. Patients with AN often use excessive exercise, indu...

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