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Impact of Glucocorticoid Use in Oncology in the Immunotherapy Era. Cells 2022; 11:cells11050770. [PMID: 35269392 PMCID: PMC8909189 DOI: 10.3390/cells11050770] [Citation(s) in RCA: 29] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2022] [Revised: 02/18/2022] [Accepted: 02/18/2022] [Indexed: 12/11/2022] Open
Abstract
Thanks to their anti-inflammatory, anti-oedema, and anti-allergy properties, glucocorticoids are among the most widely prescribed drugs in patients with cancer. The indications for glucocorticoid use are very wide and varied in the context of cancer and include the symptomatic management of cancer-related symptoms (compression, pain, oedema, altered general state) but also prevention or treatment of common side effects of anti-cancer therapies (nausea, allergies, etc.) or immune-related adverse events (irAE). In this review, we first give an overview of the different clinical situations where glucocorticoids are used in oncology. Next, we describe the current state of knowledge regarding the effects of these molecules on immune response, in particular anti-tumour response, and we summarize available data evaluating how these effects may interfere with the efficacy of immunotherapy using immune checkpoint inhibitors.
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De Giglio A, Mezquita L, Auclin E, Blanc-Durand F, Riudavets M, Caramella C, Martinez G, Benitez JC, Martín-Romano P, El-Amarti L, Hendriks L, Ferrara R, Naltet C, Lavaud P, Gazzah A, Adam J, Planchard D, Chaput N, Besse B. Impact of Intercurrent Introduction of Steroids on Clinical Outcomes in Advanced Non-Small-Cell Lung Cancer (NSCLC) Patients under Immune-Checkpoint Inhibitors (ICI). Cancers (Basel) 2020; 12:E2827. [PMID: 33007977 PMCID: PMC7599488 DOI: 10.3390/cancers12102827] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2020] [Revised: 09/25/2020] [Accepted: 09/29/2020] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Baseline steroids before ICI have been associated with poor outcomes, particularly when introduced due to cancer symptoms. METHODS Retrospective analysis of advanced NSCLC patients treated with ICI. We collected the use of intercurrent steroids (≥10 mg of prednisone-equivalent) within the first eight weeks of ICI. We correlated steroid use with patient outcomes according to the indications. RESULTS 413 patients received ICI, 299 were steroids-naïve at baseline. A total of 49 patients received intercurrent steroids (16%), of whom 38 for cancer-related symptoms and 11 for other indications, such as immune-related events. Overall, median (m) progression-free survival (PFS) was 1.9 months (mo.) [95% CI, 1.8-2.4] and overall survival (OS) 10 mo. [95% CI, 8.1-12.9]. Intercurrent steroids under ICI correlated with a shorter PFS/OS (1.3 and 2.3 mo. respectively, both p < 0.0001). Intercurrent steroids for cancer-related symptoms correlated with poorest mPFS [1.1 mo.; 95% CI, 0.9-1.5] and mOS [1.9 mo.; 95%CI, 1.5-2.4; p < 0.0001)]. No mOS and mPFS differences were found between cancer-unrelated-steroid group and no-steroid group. Steroid use for cancer-related symptoms was an independent prognostic factor for poor PFS [HR 2.64; 95% CI, 1.2-5.6] and OS [HR 4.53; 95% CI, 1.8-11.1], both p < 0.0001. CONCLUSION Intercurrent steroids during ICI had no detrimental prognostic impact if the indication was unrelated to cancer symptoms.
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Affiliation(s)
- Andrea De Giglio
- Cancer Medicine Department, Gustave Roussy, 94805 Villejuif, France; (A.D.G.); (L.M.); (F.B.-D.); (M.R.); (G.M.); (J.C.B.); (L.E.-A.); (L.H.); (R.F.); (C.N.); (P.L.); (D.P.)
- Department of Specialized, Experimental and Diagnostic Medicine, S.Orsola-Malpighi University Hospital, Alma Mater Studiorum University of Bologna, 40126 Bologna, Italy
| | - Laura Mezquita
- Cancer Medicine Department, Gustave Roussy, 94805 Villejuif, France; (A.D.G.); (L.M.); (F.B.-D.); (M.R.); (G.M.); (J.C.B.); (L.E.-A.); (L.H.); (R.F.); (C.N.); (P.L.); (D.P.)
- Medical Oncology Department, Hospital Clinic, 08036 Barcelona, Spain
- Laboratory of Translational Genomics and Targeted therapies in Solid Tumors, IDIBAPS, 08036 Barcelona, Spain
| | - Edouard Auclin
- Medical and Thoracic Oncology Department, Georges Pompidou Hospital, 75015 Paris, France;
| | - Félix Blanc-Durand
- Cancer Medicine Department, Gustave Roussy, 94805 Villejuif, France; (A.D.G.); (L.M.); (F.B.-D.); (M.R.); (G.M.); (J.C.B.); (L.E.-A.); (L.H.); (R.F.); (C.N.); (P.L.); (D.P.)
| | - Mariona Riudavets
- Cancer Medicine Department, Gustave Roussy, 94805 Villejuif, France; (A.D.G.); (L.M.); (F.B.-D.); (M.R.); (G.M.); (J.C.B.); (L.E.-A.); (L.H.); (R.F.); (C.N.); (P.L.); (D.P.)
| | | | - Gala Martinez
- Cancer Medicine Department, Gustave Roussy, 94805 Villejuif, France; (A.D.G.); (L.M.); (F.B.-D.); (M.R.); (G.M.); (J.C.B.); (L.E.-A.); (L.H.); (R.F.); (C.N.); (P.L.); (D.P.)
| | - Jose Carlos Benitez
- Cancer Medicine Department, Gustave Roussy, 94805 Villejuif, France; (A.D.G.); (L.M.); (F.B.-D.); (M.R.); (G.M.); (J.C.B.); (L.E.-A.); (L.H.); (R.F.); (C.N.); (P.L.); (D.P.)
| | - Patricia Martín-Romano
- Early Drug Development Department, Gustave Roussy, 94805 Villejuif, France; (P.M.-R.); (A.G.)
| | - Lamiae El-Amarti
- Cancer Medicine Department, Gustave Roussy, 94805 Villejuif, France; (A.D.G.); (L.M.); (F.B.-D.); (M.R.); (G.M.); (J.C.B.); (L.E.-A.); (L.H.); (R.F.); (C.N.); (P.L.); (D.P.)
| | - Lizza Hendriks
- Cancer Medicine Department, Gustave Roussy, 94805 Villejuif, France; (A.D.G.); (L.M.); (F.B.-D.); (M.R.); (G.M.); (J.C.B.); (L.E.-A.); (L.H.); (R.F.); (C.N.); (P.L.); (D.P.)
- Department of pulmonary diseases, GROW- School for Oncology and developmental biology, Maastricht UMC+, 6229 Maastricht, The Netherlands
| | - Roberto Ferrara
- Cancer Medicine Department, Gustave Roussy, 94805 Villejuif, France; (A.D.G.); (L.M.); (F.B.-D.); (M.R.); (G.M.); (J.C.B.); (L.E.-A.); (L.H.); (R.F.); (C.N.); (P.L.); (D.P.)
- Thoracic Oncology Unit, Medical Oncology Department Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, 20133 Milano, Italy
| | - Charles Naltet
- Cancer Medicine Department, Gustave Roussy, 94805 Villejuif, France; (A.D.G.); (L.M.); (F.B.-D.); (M.R.); (G.M.); (J.C.B.); (L.E.-A.); (L.H.); (R.F.); (C.N.); (P.L.); (D.P.)
| | - Pernelle Lavaud
- Cancer Medicine Department, Gustave Roussy, 94805 Villejuif, France; (A.D.G.); (L.M.); (F.B.-D.); (M.R.); (G.M.); (J.C.B.); (L.E.-A.); (L.H.); (R.F.); (C.N.); (P.L.); (D.P.)
| | - Anas Gazzah
- Early Drug Development Department, Gustave Roussy, 94805 Villejuif, France; (P.M.-R.); (A.G.)
| | - Julien Adam
- Department of Pathology, Gustave Roussy, 94805 Villejuif, France;
| | - David Planchard
- Cancer Medicine Department, Gustave Roussy, 94805 Villejuif, France; (A.D.G.); (L.M.); (F.B.-D.); (M.R.); (G.M.); (J.C.B.); (L.E.-A.); (L.H.); (R.F.); (C.N.); (P.L.); (D.P.)
| | - Nathalie Chaput
- Laboratory of Immunomonitoring in Oncology and CNRS-UMS 3655 and INSERM-US23, Gustave Roussy, 94805 Villejuif, France;
- Université Paris-Saclay, Faculté de Pharmacie, 92296 Chatenay-Malabry, France
| | - Benjamin Besse
- Cancer Medicine Department, Gustave Roussy, 94805 Villejuif, France; (A.D.G.); (L.M.); (F.B.-D.); (M.R.); (G.M.); (J.C.B.); (L.E.-A.); (L.H.); (R.F.); (C.N.); (P.L.); (D.P.)
- Université Paris-Saclay, Faculté de Médicine, 94276 Le Kremlin Bicêtre, France
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