Steroids lower survival benefits associated with immune checkpoint inhibitors in lung cancer
CHICAGO — The use of steroids at baseline was associated with inferior survival outcomes in patients with advanced non-small cell lung cancer who were starting either PD-1 or PD-L1 blockade therapy, according to retrospective data presented at ASCO Annual Meeting.
“Treatment with PD-1 and PD-L1 inhibitors is now standard therapy for nearly all patients with advanced non-small cell lung cancer,” Kathryn C. Arbour, MD, a fellow at Memorial Sloan Kettering Cancer Center, said during her presentation. “The potential impact of steroids in patients with PD-1 or PD-L1 blockade has been an open question. Steroids are frequently used as a supportive medication in cancer care and can provide rapid relief of numerous cancer-related symptoms, including dyspnea, anorexia, pain, fatigue and symptoms associated with brain metastases. However ... [physicians] routinely recognize that there can be substantial toxicities associated with long-term steroid use.”
Arbour and colleagues conducted a retrospective review of 640 patients with advanced non-small cell lung cancer (NSCLC) who were treated with a single-agent PD-1 or PD-L1 inhibitor at either Memorial Sloan Kettering Cancer Center (n = 455; median age, 66 years) or Gustave Roussy Cancer Center (n = 185; median age, 61 years) in France.
The aim of the study was to evaluate the effect of baseline steroids on the efficacy of PD-1 or PD-L1 blockade therapy.
Twelve percent of patients at Memorial Sloan Kettering Cancer Center and 20% of patients at Gustave Roussy Cancer Center received 10 mg or more of steroids at baseline.
Overall response rate by RECIST criteria, progression-free survival and overall survival from the beginning of treatment served as the primary endpoints.
Each endpoint was influenced by steroid use, Arbour said.
Six percent of patients (n = 51) at Memorial Sloan Kettering Cancer Center who received steroids at baseline reached an overall response, compared to 19% of patients (n = 400) who did not (P = .02).
At Gustave Roussy Cancer Center, 8 % of patients who received steroids at baseline (n = 37) achieved an overall response while compared with 18% of patients (n = 148) who did not.
Patients who received steroids at baseline at either Memorial Sloan Kettering Cancer Center (n = 53) or Gustave Roussy Cancer Center (n = 37) had an inferior PFS to patients who did not (P < .0001).
Overall survival was also negatively affected by steroid use in both the Memorial Sloan Kettering Cancer Center (P < .0001) and Gustave Roussy Cancer Center (P < .001) cohorts.
Based on these results, physicians should only advocate for the prudent use of steroids in patients with PD-1 or PD-L1 blockade therapies, according to Arbour.
“[Physicians should] consider the use of non-steroid alternatives for management of cancer symptoms,” she said. “However, medically necessary steroids, for example in brain metastases, should not be avoided.”
Arbour additionally noted that more research is needed on the effect of steroids on combination therapy.
“This analysis only incorporated patients who were receiving single-agent PD-1 or PD-L1 inhibitors, and therefore the implications for patients receiving chemotherapy in combination with PD-1 is uncertain,” she said. – by Ryan McDonald
Arbour KC, et al. Abstract 9003. Presented at: ASCO Annual Meeting; June 1-5, 2018; Chicago.
Disclosures: Arbour reports no relevant financial disclosures.