PROVIDENCE, RI – Does corticosteroid use affects treatment response to chemotherapy and immune-checkpoint inhibitors (CICPIs) in some types of advanced lung cancer.
Focusing on extensive-stage small-cell lung cancer (ES-SCLC) and metastatic non-small cell lung cancer (mNSCLC), a study team from the Providence, RI, VAMC, the University of Rhode Island, also in Providence, and Brigham and Women’s Hospital in Boston, sought to determine how systemic corticosteroid exposure before CICPI modifies the effect on outcomes in those lung cancer patients.
To do that, they conducted a retrospective cohort study using electronic health records to examine patients with mNSCLC or ES-SCLC who received chemotherapy (CT) between April 1, 2015, and Jan. 31, 2018, or CICPI between Feb. 1, 2018, and Aug. 31, 2019. Excluded were patients with an actionable driver mutation.
For purposes of the study, baseline corticosteroid use was defined as the use of systemic corticosteroids within 28 days before the initiation of CT or CICPI, not including premedications. The study team defined coprimary outcomes as overall survival (OS), real-world progression (rwP), and real-world progression-free survival (rwPFS) in CICPI-treated corticosteroid users vs. non-users.
The final cohort included 316 patients with a median age of 67. About half, 49% were male, and most, 228, of the participants were CT-treated, while 88 were CICPI-treated.
Results published in the European Journal of Cancer noted that after applying inverse probability of treatment weighting (IPW), “characteristics were well-balanced between the CT and CICPI groups, and steroid users and non-users.”1
Researchers used CT-treated steroid non-users as a common comparator and determined that CICPI-treated steroid users were as likely as CICPI-treated steroid non-users to die (users IPW hazard ratio [HR] = 0.67, 95% CI = 0.35-1.28 vs. non-users IPW-HR = 0.88, 95% C = I0.55-1.42; p = 0.49), have real-world progression (IPW-HR = 0.35, 95% C = I0.12-0.99 versus IPW-HR = 0.41, 95% C = I0.24-0.70; p = 0.77), or experience real-world profession-free survival (IPW-HR = 0.56, 95% C = I0.29-1.09 versus IPW-HR = 0.69, 95% CI0.46-1.03; p = 0.59).
“Corticosteroid use before CICPIs was not associated with worse outcomes, suggesting that corticosteroids should be used with CICPIs when indicated,” the authors advised.
- Sorial MN, Huynh JP, Azzoli CG, Liauw JC, Brunault RD, Collins CM, Zullo AR. Survival outcomes associated with corticosteroid use before chemoimmunotherapy in patients with advanced lung cancer. Eur J Cancer. 2021 Mar;145:234-244. doi: 10.1016/j.ejca.2020.12.011. Epub 2021 Jan 8. PMID: 33431285; PMCID: PMC7935747.
