Department of Cancer Medicine, Gustave Roussy, Villejuif, France.
Department of Medical Oncology, Besançon University Medical Center, Besançon, France; University of Bourgogne Franche-Comté, Interactions Greffon-Hôte-Tumeur/Ingénierie Cellulaire et Génique, INSERM, Besançon, France.
Eur J Cancer. 2020 Dec;141:239-251. doi: 10.1016/j.ejca.2020.09.032. Epub 2020 Nov 16.
Corticosteroids are among the most prescribed drugs in oncology. The indications range from cancer-related indications for refractory symptoms, anti-cancer effects mainly in hematology, supportive measures for cancer-specific treatments and more recently immune-related adverse events induced by modern immunotherapies. In oncological emergencies, corticosteroids are common first-line treatments because of their rapid effect and wide variety of actions. In the last 5 years, with the advance of immune checkpoint inhibitors, corticosteroids are becoming routinely used to manage immune-related adverse effects. Preclinical studies suggested that corticosteroid-induced immunosuppression might dampen the activity of immunotherapies. Prospective clinical studies show that corticosteroid use is a prognostic marker for the cancer outcome in metastatic setting but does not significantly alter the patient's response to immunotherapies per se. Here, we review the state of the art on corticosteroid use in oncology, with a focus on the drugs' potential impact on immunotherapy activity. The comprehensive pharmacological characteristics of corticosteroid drugs, clinical indications, modality of administration and associated precautions for use are discussed in this article.
皮质类固醇是肿瘤学中最常被开的药物之一。其适应证范围广泛，包括癌症相关的难治性症状、主要在血液学方面的抗癌作用、癌症特异性治疗的支持措施，以及最近由现代免疫疗法引起的免疫相关不良反应。在肿瘤急症中，由于皮质类固醇具有快速作用和广泛的作用机制，因此通常被用作一线治疗药物。在过去的 5 年中，随着免疫检查点抑制剂的进展，皮质类固醇已常规用于治疗免疫相关不良反应。临床前研究表明，皮质类固醇诱导的免疫抑制可能会抑制免疫疗法的活性。前瞻性临床研究表明，皮质类固醇的使用是转移性疾病中癌症预后的一个预后标志物，但本身并不会显著改变患者对免疫疗法的反应。在这里，我们回顾了皮质类固醇在肿瘤学中的应用现状，重点关注了这些药物对免疫疗法活性的潜在影响。本文讨论了皮质类固醇药物的全面药理学特征、临床适应证、给药方式以及相关使用注意事项。
