Department of Surgery and Cancer, Imperial College London, London, UK
Department of Gastrointestinal Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA.
J Immunother Cancer. 2020 Oct;8(2). doi: 10.1136/jitc-2020-000726.
The impact of corticosteroid therapy (CT) on efficacy of immune checkpoint inhibitors (ICI) is undefined in hepatocellular carcinoma (HCC). We evaluated whether CT administered at baseline (bCT) or concurrently with ICI (cCT) influences overall (OS), progression-free survival (PFS) and overall response rates (ORR) in 341 patients collected across 3 continents. Of 304 eligible patients, 78 (26%) received 10 mg prednisone equivalent daily either as bCT (n=14, 5%) or cCT (n=64, 21%). Indications for CT included procedure/prophylaxis (n=37, 47%), management of immune-related adverse event (n=27, 35%), cancer-related symptoms (n=8, 10%) or comorbidities (n=6, 8%). Neither overall CT, bCT nor cCT predicted for worse OS, PFS nor ORR in univariable and multivariable analyses (p>0.05). CT for cancer-related indications predicted for shorter PFS (p<0.001) and was associated with refractoriness to ICI (75% vs 33%, p=0.05) compared with cancer-unrelated indications. This is the first study to demonstrate that neither bCT nor cCT influence response and OS following ICI in HCC. Worse outcomes in CT recipients for cancer-related indications appear driven by the poor prognosis associated with symptomatic HCC.
皮质类固醇治疗（CT）对肝细胞癌（HCC）中免疫检查点抑制剂（ICI）疗效的影响尚未确定。我们评估了基线时（bCT）或同时给予 ICI 时（cCT）给予 CT 是否会影响 341 名患者的总生存期（OS）、无进展生存期（PFS）和总体反应率（ORR），这些患者分布在 3 个大洲。在 304 名符合条件的患者中，有 78 名（26%）每天接受 10mg 泼尼松等效剂量的 CT，其中 bCT（n=14，5%）或 cCT（n=64，21%）。CT 的适应证包括治疗/预防（n=37，47%）、管理免疫相关不良事件（n=27，35%）、癌症相关症状（n=8，10%）或合并症（n=6，8%）。在单变量和多变量分析中，总体 CT、bCT 或 cCT 均未预测 OS、PFS 或 ORR 更差（p>0.05）。用于癌症相关适应证的 CT 预测 PFS 更短（p<0.001），与非癌症相关适应证相比，ICI 更易产生耐药性（75%比 33%，p=0.05）。这是第一项表明在 HCC 中，bCT 或 cCT 均不影响 ICI 后的反应和 OS 的研究。癌症相关适应证的 CT 接受者的结局更差，这似乎是由于症状性 HCC 相关的不良预后所致。
