Impact of Intercurrent Introduction of Steroids on Clinical Outcomes in Advanced Non-Small-Cell Lung Cancer (NSCLC) Patients under Immune-Checkpoint Inhibitors (ICI).

Andrea De Giglio, Laura Mezquita, Edouard Auclin, Félix Blanc-Durand, Mariona Riudavets, Caroline Caramella, Gala Martinez, Jose Carlos Benitez, Patricia Martín-Romano, Lamiae El-Amarti, Lizza Hendriks, Roberto Ferrara, Charles Naltet, Pernelle Lavaud, Anas Gazzah, Julien Adam, David Planchard, Nathalie Chaput, Benjamin Besse

Research output: Contribution to journalArticlepeer-review

Abstract

BACKGROUND: Baseline steroids before ICI have been associated with poor outcomes, particularly when introduced due to cancer symptoms. METHODS: Retrospective analysis of advanced NSCLC patients treated with ICI. We collected the use of intercurrent steroids (≥10 mg of prednisone-equivalent) within the first eight weeks of ICI. We correlated steroid use with patient outcomes according to the indications. RESULTS: 413 patients received ICI, 299 were steroids-naïve at baseline. A total of 49 patients received intercurrent steroids (16, of whom 38 for cancer-related symptoms and 11 for other indications, such as immune-related events. Overall, median (m) progression-free survival (PFS) was 1.9 months (mo.) [95 1.8-2.4] and overall survival (OS) 10 mo. [95 8.1-12.9]. Intercurrent steroids under ICI correlated with a shorter PFS/OS (1.3 and 2.3 mo. respectively, both p textless 0.0001). Intercurrent steroids for cancer-related symptoms correlated with poorest mPFS [1.1 mo.; 95 0.9-1.5] and mOS [1.9 mo.; 95 1.5-2.4; p textless 0.0001)]. No mOS and mPFS differences were found between cancer-unrelated-steroid group and no-steroid group. Steroid use for cancer-related symptoms was an independent prognostic factor for poor PFS [HR 2.64; 95 1.2-5.6] and OS [HR 4.53; 95 1.8-11.1], both p textless 0.0001. CONCLUSION: Intercurrent steroids during ICI had no detrimental prognostic impact if the indication was unrelated to cancer symptoms.
Original languageEnglish
JournalCancers
Volume12
Issue number10
DOIs
Publication statusPublished - Sep 1 2020

Keywords

  • immunotherapy
  • non-small cell lung cancer
  • steroids

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