Effects of glucocorticoid use on survival of advanced non-small-cell lung cancer patients treated with immune checkpoint inhibitors  

作　　者：Nijiao Li Xuliang Zheng Jinyan Gan Ting Zhuo Xiaohong Li Chuyi Yang Yanbin Wu Shouming Qin 

机构地区：[1]The First Affiliated Hospital of Guangxi Medical University,Nanning,Guangxi 530021,China [2]Department of Pulmonary and Critical Care Medicine,The First Affiliated Hospital of Guangxi Medical University,Nanning,Guangxi 530021,China

出　　处：《Chinese Medical Journal》2023年第21期2562-2572,共11页中华医学杂志（英文版）

基　　金：supported by grants from the Guangxi Medical and Health Appropriate Technology Development and Promotion Application Project(No.S201659);the Self-financing Research Projects of Guangxi Zhuang Autonomous Region Health and Family Planning Commission(No.Z20180970).

摘　　要：Background:Lung cancer is the second most common cancer worldwide,with non-small-cell lung cancer(NSCLC)accounting for the majority of cases.Patients with NSCLC have achieved great survival benefits from immunotherapies targeting immune checkpoints.Glucocorticoids(GCs)are frequently used for palliation of cancer-associated symptoms,as supportive care for noncancer-associated symptoms,and for management of immune-related adverse events(irAEs).The aim of this study was to clarify the safety and prognostic significance of glucocorticoid use in advanced patients with NSCLC treated with immune checkpoint inhibitors(ICIs).Methods:The study searched publications from PubMed,Embase,Cochrane Library,Web of Science,China Biology Medicine disc,Chinese National Knowledge Infrastructure,Wanfang Data,and Chinese Science and Technology Journal Database up to March 1st,2022,and conducted a meta-analysis to assess the effects of glucocorticoid use on overall survival(OS)and progressionfree survival(PFS)in NSCLC patients treated with ICIs through the available data.The study calculated the pooled hazard ratios(HRs)and 95%confidence intervals(CIs).Results:This study included data from 25 literatures that were mainly retrospective,with 8713 patients included.Patients taking GCs had a higher risk for tumor progression and death compared with those not taking GCs(PFS:HR=1.57,95%CI:1.33-1.86,P<0.001;OS:HR=1.63,95%CI:1.41-1.88,P<0.001).GCs used for cancer-associated symptoms caused an obviously negative effect on both PFS and OS(PFS:HR=1.74,95%CI:1.32-2.29,P<0.001;OS:HR=1.76,95%CI:1.52-2.04,P<0.001).However,GCs used for irAEs management did not negatively affect prognosis(PFS:HR=0.68,95%CI:0.46-1.00,P=0.050;OS:HR=0.53,95%CI:0.34-0.83,P=0.005),and GCs used for non-cancer-associated indications had no effect on prognosis(PFS:HR=0.92,95%CI:0.63-1.32,P=0.640;OS:HR=0.91,95%CI:0.59-1.41,P=0.680).Conclusions:In advanced NSCLC patients treated with ICIs,the use of GCs for palliation of cancer-associated symptoms may result in a worse PFS and OS

关 键 词：GLUCOCORTICOIDS Immune checkpoint inhibitor Meta-analysis Non-small-cell lung cancer Prognosis 

分 类 号：R734.2[医药卫生—肿瘤]