• Users Online: 299
  • Print this page
  • Email this page


 
 
Table of Contents
LETTER TO EDITOR
Year : 2020  |  Volume : 3  |  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 Submission05-Jan-2020
Date of Acceptance06-Jan-2020
Date of Web Publication24-Feb-2020

Correspondence Address:
Waseem Abbas
Max Institute of Cancer Care, FC 50, C and D Blocks, Shalimar Place Site, Shalimar Bagh, Delhi - 110 088
India
Login to access the Email id

Source of Support: None, Conflict of Interest: None


DOI: 10.4103/CRST.CRST_11_20

Get Permissions


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

How to cite this URL:
Abbas W. Impact of corticosteroids and antibiotic use during treatment with immune checkpoint inhibitors. Cancer Res Stat Treat [serial online] 2020 [cited 2020 Apr 7];3:146-7. Available from: http://www.crstonline.com/text.asp?2020/3/1/146/279068



In the study by Kapoor et al.,[1],[2] 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.[3] In the current study,[1] 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[4],[5] 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,[6] 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

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Kapoor A, Noronha V, Patil VM, Joshi A, Menon N, Abraham G, et al. Concomitant use of corticosteroids and immune checkpoint inhibitors in patients with solid neoplasms: A real-world experience from a tertiary cancer center. Cancer Res Stat Treat 2019;2:204-8.  Back to cited text no. 1
  [Full text]  
2.
Rangarajan B, Abhinav RK. Beyond the tumor and tumor milieu – Factors affecting responses to immunotherapy. Cancer Res Stat Treat 2019;2:224-5.  Back to cited text no. 2
  [Full text]  
3.
Garant A, Guilbault C, Ekmekjian T, Greenwald Z, Murgoi P, Vuong T. Concomitant use of corticosteroids and immune checkpoint inhibitors in patients with hematologic or solid neoplasms: A systematic review. Crit Rev Oncol Hematol 2017;120:86-92.  Back to cited text no. 3
    
4.
Dumenil C, Massiani MA, Dumoulin J, Giraud V, Labrune S, Chinet T, et al. Clinical factors associated with early progression and grade 3-4 toxicity in patients with advanced non-small-cell lung cancers treated with nivolumab. PLoS One 2018;13:e0195945.  Back to cited text no. 4
    
5.
Muchnik E, Loh KP, Strawderman M, Magnuson A, Mohile SG, Estrah V, et al. Immune checkpoint inhibitors in real-world treatment of older adults with non-small cell lung cancer. J Am Geriatr Soc 2019;67:905-12.  Back to cited text no. 5
    
6.
Horn L, Spigel DR, Vokes EE, Holgado E, Ready N, Steins M, et al. Nivolumab versus docetaxel in previously treated patients with advanced non-small-cell lung cancer: Two-year outcomes from two randomized, open-label, phase III trials (CheckMate 017 and CheckMate 057). J Clin Oncol 2017;35:3924-33.  Back to cited text no. 6
    




 

Top
 
  Search
 
    Similar in PUBMED
   Search Pubmed for
   Search in Google Scholar for
    Access Statistics
    Email Alert *
    Add to My List *
* Registration required (free)  

 
  In this article
References

 Article Access Statistics
    Viewed375    
    Printed0    
    Emailed0    
    PDF Downloaded16    
    Comments [Add]    

Recommend this journal