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Year : 2020  |  Volume : 3  |  Issue : 1  |  Page : 147-148

Authors' reply to Chandrasekharan et al. and Abbas

Department of Medical Oncology, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, Maharashtra, India

Date of Submission01-Feb-2020
Date of Acceptance01-Feb-2020
Date of Web Publication24-Feb-2020

Correspondence Address:
Vanita Noronha
Department of Medical Oncology, Tata Memorial Hospital, Parel, Mumbai - 400 012, Maharashtra
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/CRST.CRST_48_20

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How to cite this article:
Kapoor A, Noronha V, Patil VM, Joshi A, Menon N, Prabhash K. Authors' reply to Chandrasekharan et al. and Abbas. Cancer Res Stat Treat 2020;3:147-8

How to cite this URL:
Kapoor A, Noronha V, Patil VM, Joshi A, Menon N, Prabhash K. Authors' reply to Chandrasekharan et al. and Abbas. Cancer Res Stat Treat [serial online] 2020 [cited 2020 Apr 7];3:147-8. Available from: http://www.crstonline.com/text.asp?2020/3/1/147/279155

We thank Chandrasekharanet al. and Abbas for their interest and comments on our article and the accompanying editorial.[1],[2] Chandrasekharan et al.[1] have highlighted an interesting point that the pretreatment neutrophil-to-lymphocyte ratio (NLR) appears to select patients who respond poorly to immunotherapy.[3] Such a simple biomarker if proven to be of predictive significance in larger studies, will definitely prove to be of clinical importance for selecting patients for immunotherapy. Mezquita et al. found that the lung immune prognostic index which is based on a combination of pretreatment NLR >3 and lactate dehydrogenase level greater than the upper limit of normal correlated with worse outcomes for immunotherapy, suggesting that it may serve as an important marker for the same.[4] This appears intriguing especially when clinicians are in dire need for more biomarkers for predicting the efficacy of immunotherapy. Another important point which has been considered is the significance of concurrent use of antibiotics with steroids in some patients. The patients who did not receive antibiotics had significantly better overall survival in our study.[5]

Abbas[2] has pointed out that the survival in our study was inferior to that reported in the pivotal immunotherapy trials. This is noteworthy because our study provided real-world data on consecutive patients who were offered immunotherapy. Our study gives information regarding the actual outcomes of patients who received immunotherapy as part of standard care; all these patients may not have been eligible for the clinical trials which had relatively strict selection criteria. The results of these pivotal trials may have overestimated the survival benefits from the particular therapy.[6] About 40% of the patients in our study had the Eastern Cooperative Oncology Group performance score of 2 and above. We did not find any difference in survival (both progression-free survival and overall survival) based on the indication of the use of steroids (immune-related adverse effects versus others). Further subgroup analysis would decrease the number of patients in each subgroup precluding any meaningful conclusion. We agree that analyzing a larger database from the real-world scenario will help to lead to firmer conclusions.

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There are no conflicts of interest.

  References Top

Chandrasekharan A, Sreelesh KP, Gangadharan KV. Steroids and immunotherapy: The good, bad, or the ugly? Cancer Res Stat Treat 2020;3:145-6.  Back to cited text no. 1
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Abbas W. Impact of corticosteroids and antibiotic use during treatment with immune checkpoint inhibitors. Cancer Res Stat Treat 2020;3:146-7.  Back to cited text no. 2
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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. 3
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Mezquita L, Auclin E, Ferrara R, Charrier M, Remon J, Planchard D, et al. Association of the lung immune prognostic index with immune checkpoint inhibitor outcomes in patients with advanced non-small cell lung cancer. JAMA Oncol 2018;4:351-7.  Back to cited text no. 4
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. 5
  [Full text]  
Banna GL, Passiglia F, Colonese F, Canova S, Menis J, Addeo A, et al. Immune-checkpoint inhibitors in non-small cell lung cancer: A tool to improve patients' selection. Crit Rev Oncol Hematol 2018;129:27-39.  Back to cited text no. 6


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