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  P2.04 - Immuno-oncology (ID 167)

  • Event: WCLC 2019
  • Type: Poster Viewing in the Exhibit Hall
  • Track: Immuno-oncology
  • Presentations: 1
  • Moderators:
  • Coordinates: 9/09/2019, 10:15 - 18:15, Exhibit Hall

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    P2.04-52 - Impact of Corticosteroids and Antibiotics on Efficacy of Immune-Checkpoint Inhibitors in Patients with Advanced Non-Small Cell Lung Cancer (ID 2015)

    10:15 - 18:15  |  Author(s): Joaquin Mosquera
    • Abstract
    • Slides

    Background
    

    Immune-checkpoint inhibitors (ICIs) are a standard-of-care in advanced non-small cell lung cancer (NSCLC). Corticosteroids are frequently used in symptomatic advanced NSCLC patients, but their immunosuppressive effect may reduce the efficacy of ICIs.

    Here we report our experience in patients with NSCLC and the potential impact of on-treatment use of corticosteroids and antibiotics.

    Method
    

    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 three 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.

    Result
    

    146 patients (55%) received corticosteroids: 63 (43%) for the treatment of irAEs and 83 (57%) for the management of baseline conditions. Prednisone (40%) and dexamethasone (35%) were the most commonly used types of corticosteroids. Median dose of prednisone equivalent was 50mg daily [5-1250mg], 92% patients received ≥10mg of prednisone equivalent daily. Median duration of corticosteroids was 59 days [0.5-83.0].

    OS was longer in the group of patients that did not receive corticosteroids or received <10mg prednisone equivalent daily: 14.7 months (95%CI, 11.1-18.3) vs 8.3 months (95%CI, 6.9-9.8) (p = 0.009). No differences in PFS were observed: 4.6 months (95%CI, 2.9-6.3) vs 4.2 months (95%CI, 2.5-5.9) (p = 0.359).

    Patients receiving corticosteroids for baseline condition presented shorter median overall survival than the rest of the study population: 6.5 months (95%CI, 4.6-8.3) vs 16.5 months (95%CI, 12.1-20.8) (p <0.001). 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 groups of antibiotics. No correlation between the usage of antibiotics and efficacy of ICIs was found, with median OS of 10.2 months (95%CI, 6.4-13.9) vs 12.5 months (95%CI, 9.9-15.0) (p = 0.924).

    Conclusion
    

    In our series, corticosteroid use of ≥10mg of prednisone equivalent daily was associated with significantly poorer outcomes, especially when given for baseline condition. No correlation was found between antibiotics and survival. It is important to underline that the use of corticosteroids may simply identify a population with higher volume and aggressive tumors. Prudent use of corticosteroids needs to be warranted.

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