Immune checkpoint inhibitors (ICIs) have revolutionized the treatment of advanced non-small cell lung cancer (NSCLC), offering new hope to patients battling this aggressive disease. Notably, the emergence of immune-related adverse events (irAEs), which indicate immune system activation, has shown unexpected benefits, enhancing treatment efficacy. Despite concerns surrounding the use of corticosteroids, primarily known for their immunosuppressive effects, recent findings reveal new insights.
A pivotal study conducted by researchers at İstanbul University-Cerrahpaşa assessed the interaction between irAEs and corticosteroid use among 90 patients treated with ICIs. Among those analyzed, 45 patients, or 50%, experienced irAEs. Looking closely at survival metrics, the study unveiled remarkable differences: the median overall survival (OS) for patients with irAEs stood at 52.1 months, starkly contrasted with just 14.4 months for those without these adverse effects. This significant variation was captured as having a hazard ratio of 2.71, implying more than double the survival advantage for patients experiencing irAEs.
IrAEs occur because ICIs disrupt immune system equilibrium, leading to self-reactive T cell responses against both tumor cells and normal tissues. Common manifestations include skin conditions, endocrine dysfunctions, and pneumonitis, with reported incidences aligning with prior clinical observations. "ICIs efficacy is higher in patients who developed irAEs," the study concluded, underpinning the clinical relevance of these adverse events.
Interestingly, the analysis also assessed the role of corticosteroids. Out of the total cohort, 22 patients (24%) used corticosteroids, with the majority (77.2%) necessitating them to manage irAEs. Findings showed no significant negative impact of corticosteroid therapy on patients' outcomes, with median OS reported as 26.5 months and 28.7 months for those using steroids versus those who did not.
This opens the door to important clinical dialogues concerning the management of irAEs and steroid use during immunotherapy. Previous apprehensions of corticosteroids diminishing ICI efficacy may need reevaluation. The notion is supported by the study's statement: "We did not detect any negative effects of corticosteroid use on PFS and OS." This suggests potential allowances for corticosteroid use to alleviate irAEs without compromising survival outcomes.
The results of this study, published on April 25, 2023, highlight the necessity for medical professionals to reassess treatment protocols, particularly concerning the administration of corticosteroids during immunotherapy. A nuanced approach may not only improve patient comfort during treatment but also sustain survival advantages derived from irAEs.
Future studies with larger cohorts may provide additional clarity on the enduring impacts of corticosteroid use for managing irAEs, ensuring optimal patient care strategies as ICI therapies continue to expand and evolve.