Glucocorticoid use and complications following immune checkpoint inhibitor use in melanoma

Abstract

Background Immune checkpoint inhibitors have demonstrated benefi t in the treatment of cancer, but are associated with toxicities, which often require treatment with glucocorticoids. Aims We aimed to determine the prevalence of glucocorticoid use in patients treated with immune checkpoint inhibitors for melanoma in a single centre. Methods We performed a retrospective review of patients with advanced melanoma treated with an immune checkpoint inhibitor between September 2010 and January 2017. Patients treated with glucocorticoids had a cumulative dose and duration of glucocorticoid treatment calculated. New onset hyperglycaemia was also identifi ed. Results Of 412 patients receiving immune checkpoint therapy, 157 (38%) required glucocorticoids to treat toxicities. The median cumulative glucocorticoid dose was 2,795 mg (prednisolone equivalent) with a median duration of 61 days. Twenty-seven patients receiving glucocorticoids were noted to develop new onset hyperglycaemia. Conclusions Immune-related adverse events frequently occur in patients treated with immune checkpoint inhibitors. Consequently, patients receive prolonged courses of glucocorticoids. Awareness of glucocorticoid-induced side effects is required.

Combination therapy with immune checkpoint inhibitors (ICIs); a new frontier

“…Skin and colon are the most common organs, while the normal activity of lungs, kidneys, liver, and also heart mainly impaired by ICIs alone or in combination therapies [ 241 ]. Though, corticosteroids are usually exploited to ameliorate moderate and severe irAEs, additional immunosuppressive drugs may sometimes be prerequisite [ 242 , 243 ]. Also, much efforts have recently been spent to determine predictive biomarkers for ICIs response [ 244 ].…”

Endocrine complications of immunotherapies: a review

“…While taking checkpoint inhibitors, one-third of patients take corticosteroids, mainly to treat non-endocrine adverse effects or for brain metastases. 46 Awareness of detrimental effects of steroids, such as steroidinduced hyperglycaemia, iatrogenic adrenal insufficiency or immunosuppression, should also be considered. 30…”

Endocrine toxicity of cancer immunotherapy: clinical challenges

“…A third of patients receiving a CPI will require high dose glucocorticoids for management of non-endocrine IRAEs, at doses associated with adrenal suppression ( 26 , 41 ). Therefore, caution is also required when stopping glucocorticoids in these patients in case of the development of ACTH deficiency.…”

“…A potential confounder is that around 30% of patients receiving CPIs will require high dose steroids for non-endocrine IRAEs ( 26 , 41 ), with studies suggest that 6–8% of CPI treated patients go on to develop steroid-induced hyperglycaemia ( 41 , 74 ). As such, patients with new-onset or deteriorating hyperglycaemia after CPI treatment need careful evaluation, including a history of steroid use and assessment for ketosis to ensure that CPI-induced diabetes is not missed, placing patients at particular risk of DKA.…”