Concomitant use of corticosteroids and immune checkpoint inhibitors in patients with solid neoplasms: A real-world experience from a tertiary cancer center

Abstract

Introduction: Checkpoint inhibitors (CPIs) are rapidly becoming the standard of care in solid tumors for multiple indications. Steroids due to their immunosuppressive nature might decrease the efficacy of these agents. To test this hypothesis, we performed an audit of our patients who had received CPI and concomitant steroids. Patients and Methods: This was a retrospective audit of a prospectively maintained database at Tata Memorial Hospital, Mumbai, between August 2015 and November 2018. Patients who received CPI for palliative indication were included. Overall survival (OS) was calculated from the date of the start of immunotherapy to the date of death. Data regarding the use of steroids and cumulative number of days of use were noted. Time-to-event analysis was done using Kaplan–Meier estimator, and hazard ratio (HR) was calculated using Cox proportional model. Results: A total of 155 patients were identified to have received CPI during the study period, of which 38 (24.5%) patients received steroids with prednisolone equivalent of ≥10 mg/day. The median age of the patients receiving steroids was 58.7 years (range, 22–85), and 31 (81.6%) patients were male. The median duration of steroid use was 7 (range, 2–30) days. The median OS for patients who received steroids was 3.9 months (95% confidence interval [CI], 1.8–11.4) versus 5.47 months (95% CI, 1.3–9.6) in patients who did not receive steroids (P = 0.23). The median progression-free survival for patients who received steroids for <10 days was 1.4 months (95% CI, 0.9–1.9) versus 3.8 months (95% CI, 0–8.6) for patients who received steroids for 10 or more days (P = 0.009). Using duration of steroid use as a continuous variable, HR for death was 1.0 (95% CI, 0.90–1.04, P = 0.991). There was a statistically significant better OS in patients who did not receive antibiotics (median OS, 11.4 months [95% CI, 8.5–14.3] vs. 2.8 months [95% CI, 1.5–4.1], P = 0.047). Conclusions: There was no statistical difference in OS in patients on immunotherapy with or without the use of steroids supporting the notion that steroids can be judiciously used along with CPI.