Park Soh Mee, Jeong Jonghyun, Kim Yu Jung, Lee Ju-Yeun
College of Pharmacy and Research Institute of Pharmaceutical Sciences, Seoul National University, 1, Gwanak-ro, Gwanak-gu, Seoul, 08826, Republic of Korea.
Department of Pharmacy, Seoul National University Bundang Hospital, Seongnam, Republic of Korea.
Sci Rep. 2025 Jul 1;15(1):22108. doi: 10.1038/s41598-025-05899-w.
Immune checkpoint inhibitors (ICIs) combined with conventional cytotoxic agents have become the new standard of care for extensive-stage small cell lung cancer (SCLC). The platinum-based agents in these regimens are highly emetogenic, necessitating prophylactic antiemetic steroids. This study evaluated the impact of prophylactic antiemetic steroid use on survival outcomes and efficacy in patients with SCLC undergoing combination therapy. Using data from the National Health Insurance Service of Korea database, patients treated with atezolizumab, etoposide, and carboplatin between 2020 and 2022 were categorized by antiemetic steroid dosage. Primary outcomes included overall survival (OS) and time to next treatment (TTNT), assessed using multivariable Cox proportional hazards models. After propensity score matching, 2,116 patients were categorized into low-dose (0-12 mg), moderate-dose (13-24 mg), and high-dose (25-36 mg) groups. Median OS was 10.2 months (interquartile range [IQR] 5.2-18.5), and median TTNT was 8.6 months (IQR 4.8-15.5), with no significant differences among groups. Subgroup analysis revealed increased mortality associated with higher antiemetic steroid doses in patients concurrently receiving non-antiemetic steroids. Although antiemetic steroids did not significantly impact survival outcomes overall, reducing their dosage in patients already on steroid therapy for other indications is recommended.
免疫检查点抑制剂（ICIs）与传统细胞毒性药物联合使用已成为广泛期小细胞肺癌（SCLC）的新治疗标准。这些方案中的铂类药物具有高度致吐性，因此需要预防性使用止吐类固醇。本研究评估了预防性使用止吐类固醇对接受联合治疗的SCLC患者生存结局和疗效的影响。利用韩国国民健康保险服务数据库的数据，根据止吐类固醇剂量对2020年至2022年间接受阿替利珠单抗、依托泊苷和卡铂治疗的患者进行分类。主要结局包括总生存期（OS）和下次治疗时间（TTNT），使用多变量Cox比例风险模型进行评估。在倾向评分匹配后，2116名患者被分为低剂量（0 - 12毫克）、中等剂量（13 - 24毫克）和高剂量（25 - 36毫克）组。中位OS为10.2个月（四分位间距[IQR] 5.2 - 18.5），中位TTNT为8.6个月（IQR 4.8 - 15.5），各组之间无显著差异。亚组分析显示，在同时接受非止吐类固醇的患者中，较高剂量的止吐类固醇与死亡率增加相关。尽管止吐类固醇总体上对生存结局没有显著影响，但建议在因其他适应症已接受类固醇治疗的患者中减少其剂量。
