Abstract 2881
Background
Immune-checkpoint inhibitors (ICIs) are a standard-of-care in advanced non-small cell lung cancer (NSCLC). Corticosteroids are often used in symptomatic patients, but their immunosuppressive effect may reduce the efficacy of ICIs. We report our experience in NSCLC and the potential impact of on-treatment use of corticosteroids and antibiotics.
Methods
Medical records of 267 patients with advanced NSCLC receiving ICIs from March 2013 to August 2018 were reviewed. Corticosteroid usage at the time of initiation or during ICIs treatment and administration of antibiotics from 3 months before the initiation of ICIs to 3 months after treatment end were collected. Kaplan Meier and log-rank tests were used to evaluate progression-free (PFS) and overall survival (OS). A multivariable analysis was performed to study the influence of clinical characteristics on treatment efficacy.
Results
146 patients (55%) received corticosteroids: 43% for the treatment of irAEs and 57% for the management of baseline conditions. Prednisone (40%) and dexamethasone (35%) were the most commonly used. Median dose of prednisone equivalent was 50mg daily, 92% received ≥10mg prednisone equivalent daily. Median duration of corticosteroids was 59 days. OS was longer in the group that did not receive corticosteroids or received <10mg prednisone equivalent daily: 14.7 vs 8.3 months. No differences in PFS were observed: 4.6 vs 4.2 months. Patients with corticosteroids for baseline condition presented shorter median OS than the rest of the population: 6.5 vs 16.5 months. Multivariable analysis identified corticosteroids usage as an independent variable related to poorer outcomes. 141 patients (52.8%) received antibiotics. Quinolone (37%) and penicillin (33%) were the most commonly used. No correlation between the usage of antibiotics and efficacy of ICIs was found, with median OS of 10.2 vs 12.5 months.
Conclusions
The use of ≥ 10mg of prednisone equivalent daily was associated with poorer outcomes, especially when given for baseline condition. No correlation was found between antibiotics and survival. Corticosteroids usage may identify a population with higher volume and aggressive tumors. Prudent use of corticosteroids needs to be warranted.
Clinical trial identification
Editorial acknowledgement
Legal entity responsible for the study
The authors.
Funding
Has not received any funding.
Disclosure
All authors have declared no conflicts of interest.
Resources from the same session
4614 - Predictors of Response to Checkpoint Inhibitors in Naïve and Ipilimumab-Refractory Melanoma
Presenter: Domenico Mallardo
Session: Poster Display session 3
Resources:
Abstract
2901 - IFN-γ/IL-10 ratio as predictive biomarker for response to anti-PD-1 therapy in metastatic melanoma patients
Presenter: Emilio Giunta
Session: Poster Display session 3
Resources:
Abstract
2306 - Multiplex Chromogenic Immunohistochemistry (IHC) for Spatial Analysis of Checkpoint-Positive Tumor Infiltrating Lymphocytes (TILs)
Presenter: Scott Ely
Session: Poster Display session 3
Resources:
Abstract
1678 - The role of PD-L1 expression as a predictive biomarker in advanced renal cell carcinoma: a meta-analysis of randomized clinical trials.
Presenter: Alberto Carretero-Gonzalez
Session: Poster Display session 3
Resources:
Abstract
5138 - Radiomic Features as a Non-invasive Biomarker to Predict Response to Immunotherapy in Recurrent or Metastatic Urothelial Carcinoma
Presenter: Kye Jin Park
Session: Poster Display session 3
Resources:
Abstract
5800 - Integrative combination of high-plex digital profiling techniques and cluster analysis to reveal complex immune biology in the tumor microenvironment of mesothelioma
Presenter: Carmen Ballesteros-Merino
Session: Poster Display session 3
Resources:
Abstract
5736 - Predictive factors of response to immunotherapy in 198 patients with metastatic non-microcytic lung cancer (mNSCLC): real world data from 2 university hospitals in Spain
Presenter: Juan Felipe Cordoba Ortega
Session: Poster Display session 3
Resources:
Abstract
5645 - Evaluating Lung CT Density Changes Among Patients with Extensive Stage Small Cell Lung Cancer (ES-SCLC) Treated with Thoracic Radiotherapy (TRT) alone or TRT Followed by Combined Ipilimumab (IPI) and Nivolumab (NIVO).
Presenter: Kujtim Latifi
Session: Poster Display session 3
Resources:
Abstract
1540 - Immuno-oncology therapy biomarkers differences between polyoma-virus positive and negative Merkel cell carcinomas
Presenter: Zoran Gatalica
Session: Poster Display session 3
Resources:
Abstract
4538 - Can we improve patient selection for phase 1 clinical trials (Ph1) based on Immuno-Oncology score prognostic index (VIO)?
Presenter: Ignacio Matos Garcia
Session: Poster Display session 3
Resources:
Abstract