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Open AccessArticle

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

Cancer Medicine Department, Gustave Roussy, 94805 Villejuif, France
Department of Specialized, Experimental and Diagnostic Medicine, S.Orsola-Malpighi University Hospital, Alma Mater Studiorum University of Bologna, 40126 Bologna, Italy
Medical Oncology Department, Hospital Clinic, 08036 Barcelona, Spain
Laboratory of Translational Genomics and Targeted therapies in Solid Tumors, IDIBAPS, 08036 Barcelona, Spain
Medical and Thoracic Oncology Department, Georges Pompidou Hospital, 75015 Paris, France
Radiology Department, Gustave Roussy, 94805 Villejuif, France
Early Drug Development Department, Gustave Roussy, 94805 Villejuif, France
Department of pulmonary diseases, GROW- School for Oncology and developmental biology, Maastricht UMC+, 6229 Maastricht, The Netherlands
Thoracic Oncology Unit, Medical Oncology Department Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, 20133 Milano, Italy
Department of Pathology, Gustave Roussy, 94805 Villejuif, France
Laboratory of Immunomonitoring in Oncology and CNRS-UMS 3655 and INSERM-US23, Gustave Roussy, 94805 Villejuif, France
Université Paris-Saclay, Faculté de Pharmacie, 92296 Chatenay-Malabry, France
Université Paris-Saclay, Faculté de Médicine, 94276 Le Kremlin Bicêtre, France
Author to whom correspondence should be addressed.
Cancers 2020, 12(10), 2827;
Received: 5 September 2020 / Revised: 25 September 2020 / Accepted: 29 September 2020 / Published: 30 September 2020
(This article belongs to the Section Cancer Immunology and Immunotherapy)
Recently, the introduction of immunotherapy radically changed the therapeutic algorithm of non-small-cell lung cancer as an upfront or secondary strategy. Unfortunately, the small amount of patient benefits from immune-checkpoint inhibitors (ICI) and the prognostic role of concomitant treatments are a burning open issue. The use of steroids was associated with poor outcomes during ICI. We investigated the impact of intercurrent steroids, according to clinical indication, which is actually unclear. Interestingly, the use of intercurrent steroids given for cancer-unrelated symptoms has no survival impact on our study cohort.
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% CI, 1.8-2.4] and overall survival (OS) 10 mo. [95% CI, 8.1–12.9]. Intercurrent steroids under ICI correlated with a shorter PFS/OS (1.3 and 2.3 mo. respectively, both p < 0.0001). Intercurrent steroids for cancer-related symptoms correlated with poorest mPFS [1.1 mo.; 95% CI, 0.9–1.5] and mOS [1.9 mo.; 95%CI, 1.5–2.4; p < 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% CI, 1.2–5.6] and OS [HR 4.53; 95% CI, 1.8–11.1], both p < 0.0001. Conclusion: Intercurrent steroids during ICI had no detrimental prognostic impact if the indication was unrelated to cancer symptoms. View Full-Text
Keywords: non-small cell lung cancer; immunotherapy; steroids non-small cell lung cancer; immunotherapy; steroids
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De Giglio, A.; Mezquita, L.; Auclin, E.; Blanc-Durand, F.; Riudavets, M.; Caramella, C.; Martinez, G.; Benitez, J.C.; Martín-Romano, P.; El-Amarti, L.; Hendriks, L.; Ferrara, R.; Naltet, C.; Lavaud, P.; Gazzah, A.; Adam, J.; Planchard, D.; Chaput, N.; Besse, B. Impact of Intercurrent Introduction of Steroids on Clinical Outcomes in Advanced Non-Small-Cell Lung Cancer (NSCLC) Patients under Immune-Checkpoint Inhibitors (ICI). Cancers 2020, 12, 2827.

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