Effect of pretreatment steroids on the development of immune related adverse events.

Margiotta, Philip; Caldararo, Mario; Altman, Daniel; Patel, Sheel; Li, Sharon; Clark-Garvey, Sean; Mukherji, Reetu; Holden, Thomas; Johnson, Jennifer M.; Orloff, Marlana; Weight, Ryan Michael

doi:10.1200/jco.2018.36.15_suppl.e15095

Cited by 4 publications

(5 citation statements)

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“…Our study provides clinical evidence that early short-course corticosteroids administered within 3 days following ICI injection have the potential to reduce clinically significant irAEs and prevent permanent discontinuation of effective treatment. In line with our findings, a retrospective study showed that baseline corticosteroid use before initiation of immunotherapy was significantly associated with reduction in ICI discontinuation due to irAEs in patients with various types of cancers receiving ICIs [21]. Taken together, prophylactic corticosteroids administered before and within a few days after each ICI injection have great potential to prevent or limit devastating effects of irAEs.…”

Section: Discussionsupporting

confidence: 88%

“…Despite being a reasonable candidate for irAEs prevention, corticosteroids prophylaxis has never been prospectively investigated due to a long-standing concern that corticosteroids could attenuate antitumor immunity. To date, several retrospective analyses have been conducted to resolve this concern [21][22][23][24][25][26][27][28], but all of them evaluated the effects of baseline or concurrent corticosteroids, rather than early short-course corticosteroids, on treatment efficacy. It has been widely accepted that baseline corticosteroids for cancer-related indications, such as brain metastasis or spinal cord compression, are associated with worse survival outcomes, whereas baseline corticosteroids for cancer-unrelated indications are not [25][26][27].…”

Section: Discussionmentioning

confidence: 99%

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Effects of Early Short-Course Corticosteroids on Immune-Related Adverse Events in Non-Small Cell Lung Cancer Patients Receiving Immune Checkpoint Inhibitors

Huang,

Liao,

Hsu

et al. 2023

Oncology

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Introduction: In real-world practice, most non-small cell lung cancer (NSCLC) patients receiving combined immunochemotherapy are exposed to short-course corticosteroids following immune checkpoint inhibitor (ICI) infusion to prevent chemotherapy-related adverse events. However, whether this early short-course corticosteroid use prevents immune-related adverse events (irAEs) remains unknown. Methods: Between January 1st, 2015, and December 31st, 2020, NSCLC patients who received at least one cycle of ICI with or without chemotherapy were enrolled. Early short-course corticosteroids were defined as corticosteroids administered following ICI injection and before chemotherapy on the same day and no longer than 3 days afterward. The patients were categorized as either “corticosteroid group” or “non-corticosteroid group” depending on their exposure to early short-course corticosteroid. The frequencies of irAEs requiring systemic corticosteroid use and irAEs leading to ICI discontinuation were compared between the two groups, and exploratory survival analyses were performed. Results: Among 252 eligible patients, 137 patients were categorized as “corticosteroid group” and 115 patients as “non-corticosteroid group.” The corticosteroid group enriched patients in the first-line setting (n = 75, 54.7%), compared to the non-corticosteroid group (n = 28, 24.3%). Thirty patients (21.9%) in the corticosteroid group and 35 patients (30.4%) in the non-corticosteroid group developed irAEs requiring systemic corticosteroid use (odds ratio [OR], 0.64; 95% confidence interval [CI], 0.35–1.18; p = 0.15). Eight patients (5.8%) in the corticosteroid group, as compared with 18 patients (15.7%) in the non-corticosteroid group, permanently discontinued ICI due to irAEs (OR, 0.34; 95% CI, 0.12–0.85; p = 0.013). Conclusion: Early short-course corticosteroids following each ICI injection may reduce the rate of irAEs that lead to ICIs discontinuation, warranting further investigation of its prophylactic use to mitigate clinically significant irAEs.

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Section: Discussionsupporting

confidence: 88%

Section: Discussionmentioning

confidence: 99%

Effects of Early Short-Course Corticosteroids on Immune-Related Adverse Events in Non-Small Cell Lung Cancer Patients Receiving Immune Checkpoint Inhibitors

Huang,

Liao,

Hsu

et al. 2023

Oncology

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“…After reading the full text, a further seven articles were excluded because of insufficient data, and the remaining 34 studies with 5840 patients were considered as eligible studies. 10,11,15–19,23–49 Figure 1A shows the details of the literature screen and selection.…”

Section: Resultsmentioning

confidence: 99%

“…As most of the included trials were retrospective studies, the NOS method was applied to assess the overall quality of these studies. As shown in Table 2, five studies 27,30,32,40,46 had five stars, showing high risk of bias and were considered as low to moderate quality. The main reasons lowering the overall quality were selection and outcome bias.…”

Section: Resultsmentioning

confidence: 99%

The association between immune-related adverse events and the prognosis of solid cancer patients treated with immunotherapy: a systematic review and meta-analysis

et al. 2020

Ther Adv Med Oncol

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Background: Immune-related adverse events (irAEs) are common during immune checkpoint inhibitor (ICI) treatment and reported to be associated with good survival. This study evaluated the association between onset timing of irAEs and survival of cancer patients treated with ICIs. Methods: Databases including PubMed, Embase, and the Cochrane library were systematically searched to retrieve clinical studies assessing the relationship between irAEs and survival in cancer patients with ICIs. The overall response rate for treatment response and hazard ratio (HR) for overall survival (OS) and progression-free survival (PFS) were calculated using RevMan 5.3. Subgroup analysis in terms of cancer type, ICIs type, region, specific irAEs, accordingly. Results: A total of 34 studies were included. The HRs for OS and PFS in cancer patients with versus without irAEs were 0.57 [95% confidence interval (CI): 0.44, 0.74; p < 0.0001], and 0.50 (95% CI: 0.37, 0.67; p < 0.00001), respectively. The odds ratio for overall response in cancer patients with irAEs was 4.72 (95% CI: 3.48, 6.40; p < 0.00001) compared with those without irAEs. Subgroup analyses suggested that the prognostic role of irAEs was associated with cancer types and region, but not irAEs types. The landmark analysis of OS revealed that there is a non-proportional (early) effect of irAEs on OS in ICI-treated cancer patients (landmark >12 weeks, HROS = 1.08; 95% CI: 0.89, 1.30; p = 0.46). Conclusion: Our findings suggest that the occurrence of irAEs could be a prognostic factor for cancer patients who were treated with ICIs.

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“…This is in contrast to patients who are started on glucocorticoids in response to irAEs after the initiation of ICPis treatment. In this latter group of patients, there is no apparent alteration of the therapeutic response to ICPis [ 24 , 25 ]. Recent clinical experience with ICPis has shown that melanoma patients with an intestinal flora rich in Faecalibacterium and Clostridiales species tend to have a better response to PD-1 inhibitors.…”

Section: Current Status Of Cancer Immune Therapiesmentioning

confidence: 99%

The 2018 Nobel Prize in Medicine for breakthroughs in targeting immune checkpoint inhibitors: a brief perspective

Rios

Salazar

Zhang

et al. 2019

Antibody Therapeutics

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Effect of pretreatment steroids on the development of immune related adverse events.

Cited by 4 publications

References 0 publications

Effects of Early Short-Course Corticosteroids on Immune-Related Adverse Events in Non-Small Cell Lung Cancer Patients Receiving Immune Checkpoint Inhibitors

Effects of Early Short-Course Corticosteroids on Immune-Related Adverse Events in Non-Small Cell Lung Cancer Patients Receiving Immune Checkpoint Inhibitors

The association between immune-related adverse events and the prognosis of solid cancer patients treated with immunotherapy: a systematic review and meta-analysis

The 2018 Nobel Prize in Medicine for breakthroughs in targeting immune checkpoint inhibitors: a brief perspective

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