Association of Systemic Steroid Treatment and Outcome in Patients Treated with Immune Checkpoint Inhibitors: A Real-World Analysis

• Published in: Molecules (Basel, Switzerland) Vol. 26; no. 19; p. 5789
• Main Authors: Paderi, Agnese, Gambale, Elisabetta, Botteri, Cristina, Giorgione, Roberta, Lavacchi, Daniele, Brugia, Marco, Mazzoni, Francesca, Giommoni, Elisa, Bormioli, Susanna, Amedei, Amedeo, Pillozzi, Serena, Matucci Cerinic, Marco, Antonuzzo, Lorenzo
• Format: Journal Article
• Language: English
• Published: Basel MDPI AG 24.09.2021; MDPI
• Subjects: Adverse events; Cancer; Clinical outcomes; Immune checkpoint; immune checkpoint inhibitors; Immunotherapy; Inflammation; Inflammatory bowel disease; Inhibitors; irAEs; Kidney cancer; Lung cancer; Melanoma; Metastases; Metastasis; Multivariate analysis; non-small cell cancer; Non-small cell lung carcinoma; Patients; renal cell cancer; Renal cell carcinoma; steroid; Steroid hormones; Steroids; Tumor necrosis factor-TNF
• ISSN: 1420-3049; 1420-3049
• DOI: 10.3390/molecules26195789

Background: Immune-related adverse events (irAEs) are inflammatory side effects, which can occur during immune-checkpoint(s) inhibitors (ICIs) therapy. Steroids are the first-line agents to manage irAEs because of their immunosuppressive properties. However, it is still debated whether or when steroids can be administered without abrogating the therapeutic efforts of immunotherapy. Methods: We retrospectively evaluated 146 patients with metastatic non-small cell lung cancer (NSCLC), melanoma and renal cell carcinoma (RCC) treated with ICIs. We assessed the progression-free survival (PFS) of patients treated with steroids due to an irAE compared to a no-steroid group. Results: The early treatment with steroid (within the first 30 days from the beginning of immunotherapy) was not related to a shorter PFS (p = 0.077). Interestingly, patients who were treated with steroids after 30 days from the start of immunotherapy had significantly longer PFS (p = 0.017). In a multivariate analysis, treatment with steroids after 30 days was an independent prognostic factor for PFS (HR: 0.59 [95% CI 0.36–0.97], p = 0.037). Conclusions: This retrospective study points out that early systemic steroids administration to manage irAEs might not have a detrimental effect on patient clinical outcome in NSCLC, melanoma and RCC patients.