NSCLC: effect of baseline steroids on ICI driven by palliative indications

  • Ricciuti B & al.
  • J Clin Oncol
  • 17 Jun 2019

  • curated by Kelli Whitlock Burton
  • Univadis Clinical Summaries
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Takeaway

  • A cancer-related palliative indication for baseline corticosteroids may be the driving factor for poor outcomes with immune checkpoint inhibitors (ICIs). 

Why this matters

  • Prior research found baseline corticosteroid use reduced ICI efficacy, but these findings suggest steroid use may be appropriate in some patients.

Study design

  • 650 patients, ICI therapy for advanced NSCLC and ≥10 mg prednisone equivalent within 24 hours of immunotherapy (n=93) or 0 to
  • Funding: None disclosed.

Key results

  • Receiving ≥10 mg prednisone was associated with significantly lower objective response rate (P=.04) and shorter median PFS (P=.01) and median OS (P<.001 than to mg.>
  • Patients receiving ≥10 mg prednisone for palliative cancer indications had significantly shorter median PFS (1.4 months) and OS (2.2 months) vs:
    • ≥10 mg prednisone for cancer-unrelated reasons (4.6 months, 10.7 months; all P<.001>
    • 0 to
  • No significant outcome differences with ≥10 mg prednisone for cancer-unrelated indications vs 0 to
  • ≥10 mg prednisone for palliative cancer indications was significantly associated with increased mortality (aHR, 1.60; P=.02).

Limitations

  • Single-center, retrospective study.

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