|LETTER TO EDITOR
|Year : 2020 | Volume
| Issue : 1 | Page : 146-147
Impact of corticosteroids and antibiotic use during treatment with immune checkpoint inhibitors
Department of Medical Oncology, Max Institute of Cancer Care, Delhi, India
|Date of Submission||05-Jan-2020|
|Date of Acceptance||06-Jan-2020|
|Date of Web Publication||24-Feb-2020|
Max Institute of Cancer Care, FC 50, C and D Blocks, Shalimar Place Site, Shalimar Bagh, Delhi - 110 088
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Abbas W. Impact of corticosteroids and antibiotic use during treatment with immune checkpoint inhibitors. Cancer Res Stat Treat 2020;3:146-7
In the study by Kapoor et al.,, no statistical difference was seen in median progression-free survival and overall survival (OS) for patients on immunotherapy with or without concomitant use of steroids, which was also seen with the meta-analysis done by Garant et al. In the current study, 21 (55.2%) patients received steroids for palliation of symptoms, which implies that half of the patients in the steroid group had poor performance status (PS) and 12 (31.6%) patients received steroids as a therapy for immune-mediated adverse events. Multiple retrospective studies, have shown lower benefit with immune checkpoint inhibitors (ICIs) in patients with poor PS, and PS has also proven to be a predictive factor for adverse events. It is very important to take into account the data that show decreased efficacy of ICIs in poor PS population setting, especially in the retrospective analysis. Would not it be prudent to exclude such patients from the study with brain metastasis or patients receiving steroids for ICI-mediated adverse events? In addition, the median OS for patients who received steroids was 3.9 months versus 5.5 months in patients who did not receive steroids, which is inferior to the results seen in the Checkmate studies, despite the fact that the primary site was lung in 63% of the patients followed by head and neck in 16% of the patients and ICIs were used as first- or second-line therapy in 23 (60.5%) patients, and such inferior results may be because of 39.5% poor PS population.
OS was better for patients who did not receive antibiotics as compared to patients who did.
This study clearly concludes that physicians should weigh the pros and cons of antibiotics during treatment with immunotherapy, but being more precise, it is very important to examine the impact of antibiotics within individual subgroups, especially in patients with poor PS, previous hospital admissions requiring antibiotics, incidence of drug resistance, and duration of hospital stay.
Despite being limited by sample size, geographic origin, and retrospective design, this is the first real-world data on the issue of the concomitant use of steroids and antibiotics from India.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
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