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Outcomes of Immune Checkpoint Inhibitor Treatment in Patients With Advanced NSCLC Receiving Baseline Corticosteroids

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Key Points

  • Outcomes were worse among patients receiving ≥ 10 mg prednisone vs 0 to < 10 mg.
  • Outcomes were worse among patients receiving ≥ 10 mg for palliative indications vs cancer-unrelated reasons.     

In a single-center study reported in the Journal of Clinical Oncology, Ricciuti et al found better outcomes with immune checkpoint inhibitor treatment among patients with advanced non–small cell lung cancer (NSCLC) receiving baseline prednisone equivalent of ≥ 10 mg daily for cancer-unrelated indications vs cancer-related palliative indications.

Study Details

The retrospective study included 650 patients who received programmed cell death-1 (PD-1) or programmed cell death ligand-1 (PD-L1) inhibition as monotherapy or in combination with anti–cytotoxic T-cell lymphocyte associated protein 4 (CTLA-4) inhibition between July 2011 and September 2018 at the Dana-Farber Cancer Institute. Among these, 557 were receiving prednisone equivalent of 0 to < 10 mg/day, 27 were receiving ≥ 10 mg/day for cancer-unrelated indications, and 66 were receiving ≥ 10 mg/day for cancer-related palliation at the start of immune checkpoint inhibitor treatment.  

Outcomes by Dose and Indications

Among the 650 patients, the 93 (14.3%) who received ≥ 10 mg of prednisone at baseline had shorter median progression-free survival (2.0 vs 3.4 months, P = .01) and shorter median overall survival (4.9 vs 11.2 months, P < .001) vs 557 receiving 0 to < 10 mg.  Patients who received ≥ 10 mg for palliative indications had shorter median progression-free survival vs those receiving ≥ 10 for cancer-unrelated reasons and those receiving 0 to < 10 mg (1.4 vs 4.6 vs 3.4 months, respectively, P < .001 across groups) and also had shorter median overall survival (2.2 vs 10.7 vs 11.2 months, P < .001 across groups). No significant differences in progression-free or overall survival were observed between patients receiving ≥ 10 mg for cancer-unrelated reasons and those receiving 0 to > 10 mg.  

The investigators concluded, “Although patients with NSCLC treated with ≥ 10 mg of prednisone at the time of immunotherapy initiation have worse outcomes than patients who received 0 to < 10 mg of prednisone, this difference seems to be driven by a poor-prognosis subgroup of patients who receive corticosteroids for palliative indications.”

Mark M. Awad, MD, PhD, of the Lowe Center for Thoracic Oncology, Dana-Farber Cancer Institute, is the corresponding author for the Journal of Clinical Oncology article.

Disclosure: For full disclosures of the study authors, visit jco.ascopubs.org.

The content in this post has not been reviewed by the American Society of Clinical Oncology, Inc. (ASCO®) and does not necessarily reflect the ideas and opinions of ASCO®.


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