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Impact of the corticosteroid indication and administration route on overall survival and the tumor response after immune checkpoint inhibitor initiation
BACKGROUND: Based on their indications, systemic corticosteroids appear to negatively affect clinical outcomes in immune checkpoint inhibitor (ICI)-treated patients. There are few data on the influence of topical and inhaled corticosteroids on the ICIs’ effectiveness. METHODS: In a single-center stu...
Autores principales: | , , , , , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
SAGE Publications
2021
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7923985/ https://www.ncbi.nlm.nih.gov/pubmed/33717227 http://dx.doi.org/10.1177/1758835921996656 |
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author | Gaucher, Louis Adda, Leslie Séjourné, Alice Joachim, Camille Chaby, Guillaume Poulet, Claire Liabeuf, Sophie Gras-Champel, Valérie Masmoudi, Kamel Moreira, Aurélie Bennis, Youssef Batteux, Benjamin |
author_facet | Gaucher, Louis Adda, Leslie Séjourné, Alice Joachim, Camille Chaby, Guillaume Poulet, Claire Liabeuf, Sophie Gras-Champel, Valérie Masmoudi, Kamel Moreira, Aurélie Bennis, Youssef Batteux, Benjamin |
author_sort | Gaucher, Louis |
collection | PubMed |
description | BACKGROUND: Based on their indications, systemic corticosteroids appear to negatively affect clinical outcomes in immune checkpoint inhibitor (ICI)-treated patients. There are few data on the influence of topical and inhaled corticosteroids on the ICIs’ effectiveness. METHODS: In a single-center study, we retrospectively investigated the impact of systemic corticosteroids according to their indication [an immune-related adverse event (irAE) or another indication] on overall survival (OS) and the tumor response in all consecutive patients after initiation of ipilimumab, nivolumab or pembrolizumab over a 9-year period. The impacts of topical and inhaled corticosteroids were also examined. RESULTS: Three hundred and seventy-two patients were included. The mean ± standard deviation age was 64.0 ± 12.1 years. The most frequently prescribed ICI was nivolumab (in 58.3% of the patients) and the most frequent indications were lung cancer (44.6%) and melanoma (29.6%). Systemic corticosteroid use for an irAE did not have a negative impact on OS [adjusted hazard ratio (HR) [95% confidence interval (CI)] 1.04 (0.56–1.95), p = 0.902] or the best overall tumor response [adjusted odds ratio (OR) (95% CI) 1.69 (0.52–6.56), p = 0.413], while systemic corticosteroid use for another indication was associated with shorter OS [adjusted HR (95% CI) 1.34 (1.05–2.03), p = 0.046] and a poor best overall tumor response [adjusted OR (95% CI) 2.04 (1.07–5.80), p = 0.039] with a cumulative dose cut-off of 3215 mg prednisolone equivalent (specificity 71.4%; sensitivity 65.3%) and a time cut-off of 132 days (specificity 71.4%; sensitivity 89.8%). The use of topical corticosteroids was associated with a longer OS; this was probably due to dermatological irAEs. Inhaled corticosteroid use did not influence OS. CONCLUSION: Systemic corticosteroid use for an irAE does not impact OS or the tumor response, whereas use for other indications (themselves often associated with a worse prognosis) does. Topical and inhaled steroids do not have a negative impact on OS. |
format | Online Article Text |
id | pubmed-7923985 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2021 |
publisher | SAGE Publications |
record_format | MEDLINE/PubMed |
spelling | pubmed-79239852021-03-11 Impact of the corticosteroid indication and administration route on overall survival and the tumor response after immune checkpoint inhibitor initiation Gaucher, Louis Adda, Leslie Séjourné, Alice Joachim, Camille Chaby, Guillaume Poulet, Claire Liabeuf, Sophie Gras-Champel, Valérie Masmoudi, Kamel Moreira, Aurélie Bennis, Youssef Batteux, Benjamin Ther Adv Med Oncol Original Research BACKGROUND: Based on their indications, systemic corticosteroids appear to negatively affect clinical outcomes in immune checkpoint inhibitor (ICI)-treated patients. There are few data on the influence of topical and inhaled corticosteroids on the ICIs’ effectiveness. METHODS: In a single-center study, we retrospectively investigated the impact of systemic corticosteroids according to their indication [an immune-related adverse event (irAE) or another indication] on overall survival (OS) and the tumor response in all consecutive patients after initiation of ipilimumab, nivolumab or pembrolizumab over a 9-year period. The impacts of topical and inhaled corticosteroids were also examined. RESULTS: Three hundred and seventy-two patients were included. The mean ± standard deviation age was 64.0 ± 12.1 years. The most frequently prescribed ICI was nivolumab (in 58.3% of the patients) and the most frequent indications were lung cancer (44.6%) and melanoma (29.6%). Systemic corticosteroid use for an irAE did not have a negative impact on OS [adjusted hazard ratio (HR) [95% confidence interval (CI)] 1.04 (0.56–1.95), p = 0.902] or the best overall tumor response [adjusted odds ratio (OR) (95% CI) 1.69 (0.52–6.56), p = 0.413], while systemic corticosteroid use for another indication was associated with shorter OS [adjusted HR (95% CI) 1.34 (1.05–2.03), p = 0.046] and a poor best overall tumor response [adjusted OR (95% CI) 2.04 (1.07–5.80), p = 0.039] with a cumulative dose cut-off of 3215 mg prednisolone equivalent (specificity 71.4%; sensitivity 65.3%) and a time cut-off of 132 days (specificity 71.4%; sensitivity 89.8%). The use of topical corticosteroids was associated with a longer OS; this was probably due to dermatological irAEs. Inhaled corticosteroid use did not influence OS. CONCLUSION: Systemic corticosteroid use for an irAE does not impact OS or the tumor response, whereas use for other indications (themselves often associated with a worse prognosis) does. Topical and inhaled steroids do not have a negative impact on OS. SAGE Publications 2021-02-27 /pmc/articles/PMC7923985/ /pubmed/33717227 http://dx.doi.org/10.1177/1758835921996656 Text en © The Author(s), 2021 https://creativecommons.org/licenses/by-nc/4.0/ This article is distributed under the terms of the Creative Commons Attribution-NonCommercial 4.0 License (https://creativecommons.org/licenses/by-nc/4.0/) which permits non-commercial use, reproduction and distribution of the work without further permission provided the original work is attributed as specified on the SAGE and Open Access page (https://us.sagepub.com/en-us/nam/open-access-at-sage). |
spellingShingle | Original Research Gaucher, Louis Adda, Leslie Séjourné, Alice Joachim, Camille Chaby, Guillaume Poulet, Claire Liabeuf, Sophie Gras-Champel, Valérie Masmoudi, Kamel Moreira, Aurélie Bennis, Youssef Batteux, Benjamin Impact of the corticosteroid indication and administration route on overall survival and the tumor response after immune checkpoint inhibitor initiation |
title | Impact of the corticosteroid indication and administration route on overall survival and the tumor response after immune checkpoint inhibitor initiation |
title_full | Impact of the corticosteroid indication and administration route on overall survival and the tumor response after immune checkpoint inhibitor initiation |
title_fullStr | Impact of the corticosteroid indication and administration route on overall survival and the tumor response after immune checkpoint inhibitor initiation |
title_full_unstemmed | Impact of the corticosteroid indication and administration route on overall survival and the tumor response after immune checkpoint inhibitor initiation |
title_short | Impact of the corticosteroid indication and administration route on overall survival and the tumor response after immune checkpoint inhibitor initiation |
title_sort | impact of the corticosteroid indication and administration route on overall survival and the tumor response after immune checkpoint inhibitor initiation |
topic | Original Research |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7923985/ https://www.ncbi.nlm.nih.gov/pubmed/33717227 http://dx.doi.org/10.1177/1758835921996656 |
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