Department of Medical Oncology, National Taiwan University Cancer Center, Taipei, Taiwan.
Department of Oncology, National Taiwan University Hospital, Taipei, Taiwan.
Oncology. 2024;102(4):318-326. doi: 10.1159/000534350. Epub 2023 Sep 29.
In real-world practice, most non-small cell lung cancer (NSCLC) patients receiving combined immunochemotherapy are exposed to short-course corticosteroids following immune checkpoint inhibitor (ICI) infusion to prevent chemotherapy-related adverse events. However, whether this early short-course corticosteroid use prevents immune-related adverse events (irAEs) remains unknown.
Between January 1st, 2015, and December 31st, 2020, NSCLC patients who received at least one cycle of ICI with or without chemotherapy were enrolled. Early short-course corticosteroids were defined as corticosteroids administered following ICI injection and before chemotherapy on the same day and no longer than 3 days afterward. The patients were categorized as either "corticosteroid group" or "non-corticosteroid group" depending on their exposure to early short-course corticosteroid. The frequencies of irAEs requiring systemic corticosteroid use and irAEs leading to ICI discontinuation were compared between the two groups, and exploratory survival analyses were performed.
Among 252 eligible patients, 137 patients were categorized as "corticosteroid group" and 115 patients as "non-corticosteroid group." The corticosteroid group enriched patients in the first-line setting (n = 75, 54.7%), compared to the non-corticosteroid group (n = 28, 24.3%). Thirty patients (21.9%) in the corticosteroid group and 35 patients (30.4%) in the non-corticosteroid group developed irAEs requiring systemic corticosteroid use (odds ratio [OR], 0.64; 95% confidence interval [CI], 0.35-1.18; p = 0.15). Eight patients (5.8%) in the corticosteroid group, as compared with 18 patients (15.7%) in the non-corticosteroid group, permanently discontinued ICI due to irAEs (OR, 0.34; 95% CI, 0.12-0.85; p = 0.013).
Early short-course corticosteroids following each ICI injection may reduce the rate of irAEs that lead to ICIs discontinuation, warranting further investigation of its prophylactic use to mitigate clinically significant irAEs.
在实际临床实践中，大多数接受免疫检查点抑制剂（ICI）联合化疗的非小细胞肺癌（NSCLC）患者在接受 ICI 输注后会接受短期皮质类固醇治疗，以预防化疗相关不良反应。然而，早期短期使用皮质类固醇是否能预防免疫相关不良事件（irAEs）尚不清楚。
2015 年 1 月 1 日至 2020 年 12 月 31 日期间，纳入至少接受一个周期 ICI 联合或不联合化疗的 NSCLC 患者。早期短期皮质类固醇定义为 ICI 注射后当天，与化疗同时或之后不超过 3 天给予的皮质类固醇。根据患者是否接受早期短期皮质类固醇治疗，将患者分为“皮质类固醇组”或“非皮质类固醇组”。比较两组中需要全身皮质类固醇治疗的 irAEs 发生率和导致 ICI 停药的 irAEs 发生率，并进行探索性生存分析。
在 252 名符合条件的患者中，137 名患者被归类为“皮质类固醇组”，115 名患者被归类为“非皮质类固醇组”。皮质类固醇组患者在一线治疗中更为丰富（n = 75，54.7%），而非皮质类固醇组（n = 28，24.3%）。皮质类固醇组有 30 名（21.9%）患者和非皮质类固醇组有 35 名（30.4%）患者发生需要全身皮质类固醇治疗的 irAEs（优势比 [OR]，0.64；95%置信区间 [CI]，0.35-1.18；p = 0.15）。皮质类固醇组有 8 名（5.8%）患者因 irAEs 而永久性停用 ICI，而非皮质类固醇组有 18 名（15.7%）患者（OR，0.34；95%CI，0.12-0.85；p = 0.013）。
ICI 每次注射后给予早期短期皮质类固醇可能会降低导致 ICI 停药的 irAEs 发生率，这需要进一步研究其预防性使用以减轻临床上有意义的 irAEs。
