Palliative- and non-palliative indications for glucocorticoids use in course of immune-checkpoint inhibition. Current evidence and future perspectives

Daniele Marinelli, Raffaele Giusti, Marco Mazzotta, Marco Filetti, Eriseld Krasniqi, Laura Pizzuti, Lorenza Landi, Silverio Tomao, Federico Cappuzzo, Gennaro Ciliberto, Maddalena Barba, Patrizia Vici, Paolo Marchetti

Research output: Contribution to journalReview articlepeer-review

Abstract

Immune-checkpoint inhibitors significantly reshaped treatment landscapes in several solid tumors. Concurrently with disease-oriented therapies, cancer patients often require proper management of drug-related adverse events and/or cancer-related symptoms. Glucocorticoids (GC) are a cornerstone of symptom management in advanced cancer care and in the management of immune-related adverse events (irAEs) due to immune-modulating therapies. Moreover, GC are often administered in patients with autoimmune diseases (AID), either alone or in combination with other treatments. While handling of irAEs with GC is supported by multiple guidelines, it is unclear whether GC administration because of pre-existing AID or because of palliative needs is associated with inferior outcomes in cancer patients treated with immune-checkpoint inhibitors (ICIs). When globally considered, the available evidence seems to orient towards less favorable survival outcomes when GC administration is driven by a palliative intent. Conversely, steroid administration for non-palliative intent seems to be associated with stable or negligibly reduced survival outcomes.

Original languageEnglish
JournalCritical Reviews in Oncology/Hematology
Volume157
DOIs
Publication statusPublished - 2020

Keywords

  • Glucocorticoids/therapeutic use
  • Humans
  • Immune Checkpoint Inhibitors
  • Immunotherapy
  • Neoplasms/drug therapy
  • Palliative Care

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