Use of Corticosteroids With PD-1 or PD-L1 Inhibitors Associated With Poorer Outcomes in NSCLC
Lung cancer cells, coloured scanning electron micrograph (SEM).
The use of corticosteroids at baseline is associated with poorer outcomes in patients with non-small cell lung cancer (NSCLC) who were also treated with programmed cell death 1 (PD-1) or programmed death ligand-1 (PD-L1) inhibitors.
PD-L1 inhibitors are now commonly used as a standard therapy for patients with lung cancer. However, such patients also receive corticosteroids to alleviate symptoms of fatigue, dyspnea, decreased appetite, and symptomatic brain metastases. Although the simultaneous use of corticosteroids during treatment does not affect efficacy, little is known about the use of corticosteroids at baseline. A study published in the Journal of Clinical Oncology reports on an assessment of the effect of using corticosteroids at baseline simultaneously with PD-L1 inhibitors.1
The researchers retrospectively identified patients with NSCLC from Memorial Sloan Kettering Cancer Center and Gustave Roussy Cancer Center who were treated with single agent PD-L1 blockade. The researchers reviewed patient clinical and pharmacy records to identify corticosteroid use at baseline.
They found that 14% of patients treated with a single-agent PD-L1 blockade were also given prednisone 10 mg daily or higher at the start of PD-L1 blockade treatment. Use of the combination at baseline was associated with a decreased overall response to treatment at both centers.
After adjusting for smoking history, performance status, and history of brain metastases, concurrent use of corticosteroids and PD-L1 blockade at baseline were significantly associated with decreased progression-free survival and overall survival. Therefore, the authors recommend prudent use of corticosteroids at the time of initiating PD-L1 blockade.
Arbour KC, Mezquita L, Long N, Rizvi H, Auclin E, Ni A. Impact of baseline steroids on efficacy of programmed cell death-1 and programmed death-ligand 1 blockade in patients with non–small-cell lung cancer. J Clin Oncol. 2018;36(28):2872-2878.