How to manage patients with corticosteroids in oncology in the era of immunotherapy?. (December 2020)

• Record Type: Journal Article
• Authors: Aldea, Mihaela; Orillard, Emeline; Mansi, Laura; Marabelle, Aurélien; Scotte, Florian; Lambotte, Olivier; Michot, Jean-Marie
• Is Part Of: European journal of cancer. Volume 141(2020)
• Page Start: 239
• Page End: 251
• Publication Date: 2020-12
• Subjects: Corticosteroid -- Cancer -- Immunotherapy -- Immune-related adverse event -- T-cell lymphocyte; Cancer -- Periodicals; Neoplasms -- Periodicals; Cancer -- Périodiques; Cancer; Tumors; Electronic journals; Periodicals; Electronic journals; 616.994
• DOI: 10.1016/j.ejca.2020.09.032
• Languages: English
• ISSNs: 0959-8049

Abstract

Abstract: Corticosteroids are among the most prescribed drugs in oncology. The indications range from cancer-related indications for refractory symptoms, anti-cancer effects mainly in hematology, supportive measures for cancer-specific treatments and more recently immune-related adverse events induced by modern immunotherapies. In oncological emergencies, corticosteroids are common first-line treatments because of their rapid effect and wide variety of actions. In the last 5 years, with the advance of immune checkpoint inhibitors, corticosteroids are becoming routinely used to manage immune-related adverse effects. Preclinical studies suggested that corticosteroid-induced immunosuppression might dampen the activity of immunotherapies. Prospective clinical studies show that corticosteroid use is a prognostic marker for the cancer outcome in metastatic setting but does not significantly alter the patient's response to immunotherapies per se. Here, we review the state of the art on corticosteroid use in oncology, with a focus on the drugs' potential impact on immunotherapy activity. The comprehensive pharmacological characteristics of corticosteroid drugs, clinical indications, modality of administration and associated precautions for use are discussed in this article. Highlights: Corticosteroids have multiple indications that recently increase in immuno-oncology. Corticosteroids have miscellaneous adverse events and should be used with caution. Corticosteroids do not impact the efficacy of immunotherapy in metastatic patients. Corticosteroids use may compromise the efficacy of immunotherapy in adjuvant setting. Prolonged corticosteroid use should be accompanied by a d hoc anti-infectious prophylaxis.