Survival outcomes associated with corticosteroid use before chemoimmunotherapy in patients with advanced lung cancer
Copyright © 2020 Elsevier Ltd. All rights reserved..
BACKGROUND: How corticosteroid use affects treatment response to chemotherapy and immune-checkpoint inhibitors (CICPIs) remains unknown. We assessed how systemic corticosteroid exposure before CICPI modifies the effect of CICPI on outcomes among patients with metastatic non-small cell lung cancer (mNSCLC) or extensive-stage small-cell lung cancer (ES-SCLC).
METHODS: We conducted a retrospective cohort study using electronic health records to examine patients with mNSCLC or ES-SCLC who received chemotherapy (CT) between 1st April 2015 and 31st January 2018 or CICPI between 1st February 2018 and 31st August 2019. We excluded those with an actionable driver mutation. Baseline corticosteroid use was defined as systemic corticosteroids within 28 days before the initiation of CT or CICPI, not including premedications. Coprimary outcomes included overall survival (OS), real-world progression (rwP), and real-world progression-free survival (rwPFS) in CICPI-treated corticosteroid users versus non-users. We used inverse probability of treatment weighting (IPW) to adjust for potential confounding.
RESULTS: The cohort of 316 patients (median [interquartile range] age, 67 [61-73] years; 156 [49%] male) included 228 CT-treated and 88 CICPI-treated patients. After applying IPW, characteristics were well-balanced between the CT and CICPI groups, and steroid users and non-users. Using CT-treated steroid non-users as a common comparator, CICPI-treated steroid users were as likely as CICPI-treated steroid non-users to die (users IPW hazard ratio [HR] = 0.67, 95% CI = 0.35-1.28 versus non-users IPW-HR = 0.88, 95% C = I0.55-1.42; p = 0.49), have rwP (IPW-HR = 0.35, 95% C = I0.12-0.99 versus IPW-HR = 0.41, 95% C = I0.24-0.70; p = 0.77), or experience rwPFS (IPW-HR = 0.56, 95% C = I0.29-1.09 versus IPW-HR = 0.69, 95% CI0.46-1.03; p = 0.59).
CONCLUSION: Corticosteroid use before CICPIs was not associated with worse outcomes, suggesting that corticosteroids should be used with CICPIs when indicated.
| Errataetall: |
CommentIn: Eur J Cancer. 2021 Mar;145:255-257. - PMID 33419646 |
|---|---|
| Medienart: |
E-Artikel |
| Erscheinungsjahr: |
2021 |
|---|---|
| Erschienen: |
2021 |
| Enthalten in: |
Zur Gesamtaufnahme - volume:145 |
|---|---|
| Enthalten in: |
European journal of cancer (Oxford, England : 1990) - 145(2021) vom: 05. März, Seite 234-244 |
| Sprache: |
Englisch |
|---|
| Beteiligte Personen: |
Sorial, Mark N [VerfasserIn] |
|---|
| Links: |
|---|
| Anmerkungen: |
Date Completed 20.09.2021 Date Revised 07.04.2023 published: Print-Electronic CommentIn: Eur J Cancer. 2021 Mar;145:255-257. - PMID 33419646 Citation Status MEDLINE |
|---|
| doi: |
10.1016/j.ejca.2020.12.011 |
|---|
| funding: |
|
|---|---|
| Förderinstitution / Projekttitel: |
|
| PPN (Katalog-ID): |
NLM319947173 |
|---|
| LEADER | 01000naa a22002652 4500 | ||
|---|---|---|---|
| 001 | NLM319947173 | ||
| 003 | DE-627 | ||
| 005 | 20231225172532.0 | ||
| 007 | cr uuu---uuuuu | ||
| 008 | 231225s2021 xx |||||o 00| ||eng c | ||
| 024 | 7 | |a 10.1016/j.ejca.2020.12.011 |2 doi | |
| 028 | 5 | 2 | |a pubmed24n1066.xml |
| 035 | |a (DE-627)NLM319947173 | ||
| 035 | |a (NLM)33431285 | ||
| 035 | |a (PII)S0959-8049(20)31427-1 | ||
| 040 | |a DE-627 |b ger |c DE-627 |e rakwb | ||
| 041 | |a eng | ||
| 100 | 1 | |a Sorial, Mark N |e verfasserin |4 aut | |
| 245 | 1 | 0 | |a Survival outcomes associated with corticosteroid use before chemoimmunotherapy in patients with advanced lung cancer |
| 264 | 1 | |c 2021 | |
| 336 | |a Text |b txt |2 rdacontent | ||
| 337 | |a ƒaComputermedien |b c |2 rdamedia | ||
| 338 | |a ƒa Online-Ressource |b cr |2 rdacarrier | ||
| 500 | |a Date Completed 20.09.2021 | ||
| 500 | |a Date Revised 07.04.2023 | ||
| 500 | |a published: Print-Electronic | ||
| 500 | |a CommentIn: Eur J Cancer. 2021 Mar;145:255-257. - PMID 33419646 | ||
| 500 | |a Citation Status MEDLINE | ||
| 520 | |a Copyright © 2020 Elsevier Ltd. All rights reserved. | ||
| 520 | |a BACKGROUND: How corticosteroid use affects treatment response to chemotherapy and immune-checkpoint inhibitors (CICPIs) remains unknown. We assessed how systemic corticosteroid exposure before CICPI modifies the effect of CICPI on outcomes among patients with metastatic non-small cell lung cancer (mNSCLC) or extensive-stage small-cell lung cancer (ES-SCLC) | ||
| 520 | |a METHODS: We conducted a retrospective cohort study using electronic health records to examine patients with mNSCLC or ES-SCLC who received chemotherapy (CT) between 1st April 2015 and 31st January 2018 or CICPI between 1st February 2018 and 31st August 2019. We excluded those with an actionable driver mutation. Baseline corticosteroid use was defined as systemic corticosteroids within 28 days before the initiation of CT or CICPI, not including premedications. Coprimary outcomes included overall survival (OS), real-world progression (rwP), and real-world progression-free survival (rwPFS) in CICPI-treated corticosteroid users versus non-users. We used inverse probability of treatment weighting (IPW) to adjust for potential confounding | ||
| 520 | |a RESULTS: The cohort of 316 patients (median [interquartile range] age, 67 [61-73] years; 156 [49%] male) included 228 CT-treated and 88 CICPI-treated patients. After applying IPW, characteristics were well-balanced between the CT and CICPI groups, and steroid users and non-users. Using CT-treated steroid non-users as a common comparator, CICPI-treated steroid users were as likely as CICPI-treated steroid non-users to die (users IPW hazard ratio [HR] = 0.67, 95% CI = 0.35-1.28 versus non-users IPW-HR = 0.88, 95% C = I0.55-1.42; p = 0.49), have rwP (IPW-HR = 0.35, 95% C = I0.12-0.99 versus IPW-HR = 0.41, 95% C = I0.24-0.70; p = 0.77), or experience rwPFS (IPW-HR = 0.56, 95% C = I0.29-1.09 versus IPW-HR = 0.69, 95% CI0.46-1.03; p = 0.59) | ||
| 520 | |a CONCLUSION: Corticosteroid use before CICPIs was not associated with worse outcomes, suggesting that corticosteroids should be used with CICPIs when indicated | ||
| 650 | 4 | |a Journal Article | |
| 650 | 4 | |a Observational Study | |
| 650 | 4 | |a Research Support, N.I.H., Extramural | |
| 650 | 4 | |a Research Support, Non-U.S. Gov't | |
| 650 | 4 | |a Research Support, U.S. Gov't, Non-P.H.S. | |
| 650 | 4 | |a Corticosteroids | |
| 650 | 4 | |a Non-small cell lung cancer | |
| 650 | 4 | |a Programmed cell death 1 ligand 1 | |
| 650 | 4 | |a Programmed cell death 1 protein | |
| 650 | 4 | |a Small-cell lung cancer | |
| 650 | 7 | |a Adrenal Cortex Hormones |2 NLM | |
| 650 | 7 | |a Immune Checkpoint Inhibitors |2 NLM | |
| 700 | 1 | |a Huynh, Justin P |e verfasserin |4 aut | |
| 700 | 1 | |a Azzoli, Christopher G |e verfasserin |4 aut | |
| 700 | 1 | |a Liauw, Justin C |e verfasserin |4 aut | |
| 700 | 1 | |a Brunault, Robert D |e verfasserin |4 aut | |
| 700 | 1 | |a Collins, Christine M |e verfasserin |4 aut | |
| 700 | 1 | |a Zullo, Andrew R |e verfasserin |4 aut | |
| 773 | 0 | 8 | |i Enthalten in |t European journal of cancer (Oxford, England : 1990) |d 1991 |g 145(2021) vom: 05. März, Seite 234-244 |w (DE-627)NLM012602779 |x 1879-0852 |7 nnns |
| 773 | 1 | 8 | |g volume:145 |g year:2021 |g day:05 |g month:03 |g pages:234-244 |
| 856 | 4 | 0 | |u http://dx.doi.org/10.1016/j.ejca.2020.12.011 |3 Volltext |
| 912 | |a GBV_USEFLAG_A | ||
| 912 | |a GBV_NLM | ||
| 951 | |a AR | ||
| 952 | |d 145 |j 2021 |b 05 |c 03 |h 234-244 | ||