Publication-only abstracts (abstract number preceded by an "e"), published in conjunction with the 2018 ASCO Annual Meeting but not presented at the Meeting, can be found online only.
Effect of pretreatment steroids on the development of immune related adverse events.
Immune Checkpoint Inhibitors
2018 ASCO Annual Meeting
J Clin Oncol 36, 2018 (suppl; abstr e15095)
Author(s): Philip Margiotta, Mario Caldararo, Daniel Altman, Sheel A. Patel, Sharon Li, Sean Clark-Garvey, Reetu Mukherji, Thomas Holden, Jennifer Maria Johnson, Marlana M. Orloff, Ryan Michael Weight; Thomas Jefferson University, Philadelphia, PA; Thomas Jefferson University, Philadelphia, PA, US; Thomas Jefferson University, Department of Medical Oncology, Philadelphia, PA; Sidney Kimmel Medical College of Thomas Jefferson University, Philadelphia, PA
Background: Immune checkpoint blockade is being used with increasing frequency across a variety of tumor types. Corticosteroids are used in diverse clinical scenarios and can have immune-modulatory effects. The administration of steroids with immune checkpoint blockade in combination with cytotoxic chemotherapy has not diminished treatment efficacy in select patient populations1. However, the effect of steroids on the development of immune-related adverse events (irAEs) across tumor types is unknown. We hypothesized that pretreatment with corticosteroids reduces treatment-limiting irAEs. Methods: A single institution registry of patients (n = 163) receiving immune checkpoint blockade, including anti-CTLA-4 antibody (n = 51) or anti-PD-1 antibody (n = 112), was reviewed. Various primary tumor types were included (33% melanoma, 31% non-small cell lung, 36% other). Patients were determined to have discontinued treatment because of irAEs versus any other cause (disease progression, infection, comorbidity, or death). Results: None of the 17 patients (0%) who were receiving corticosteroids prior to starting immunotherapy experienced treatment-limiting irAEs (average dose 34mg/day prednisone or equivalent, only one patient taking < 10mg/day prednisone). This is compared to 29 of 146 patients (19.9%) who were not taking steroids at the start of treatment (p = 0.045). Interestingly, pretreatment steroids were not associated with an increase in disease progression or death. Conclusions: Incidence of treatment-limiting immune-related adverse events was significantly decreased, regardless of tumor type, in patients receiving corticosteroids prior to initiation of immunotherapy. An associated decrease in treatment efficacy was not seen.
|Treatment-Limiting Adverse Events - n (%)|
|Immune||Infection or Comorbidity||Disease Progression or Death||Ongoing Treatment||Total|
|On Steroids When |
|Yes||0 (0)||7 (41.1)||8 (47.1)||2 (11.8)||17 (100)|
|No||29 (19.9)||19 (13.0)||71 (48.6)||27 (18.5)||146 (100)|
|Total||29 (17.8)||26 (16.0)||79 (48.4)||29 (17.8)||163 (100)|