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Corticosteroids for cirAEs May Have No Impact on Cancer Survival

NEW YORK (Reuters Health) – Use of systemic corticosteroids to treat cutaneous immune-related adverse events (cirAEs) brought on by immune-checkpoint inhibitor (ICI) cancer therapy does not appear to have any significant impact on survival, according to a retrospective cohort study.

However, Dr. Steven T. Chen told Reuters Health by email, “Based on our findings, the jury is still out on the effect of high-dose systemic steroids on survival for patients with skin toxicity from ICIs because compared to other specialties, dermatologists don’t use high-dose systemic corticosteroids at the same rate. That said, low-dose systemic corticosteroids weren’t associated with worsened survival, suggesting we may be able to reach for this treatment option when medically indicated.”

Dr. Chen and colleagues of Massachusetts General Hospital, Harvard Medical School, in Boston, analyzed data on almost 2,500 patients who initiated anti-programmed cell death 1/ligand 1 and/or anti-cytotoxic T lymphocyte-associated antigen 4 ICI therapy at their institution between 2016 and 2019.

Of this group, 358 (15%) developed a cirAE after ICI initiation that was consistent with established morphologic categories and attributed to ICI by the evaluating oncologist or dermatologist. The patients’ median age was 64 years and melanoma and non-small-cell lung cancer were the most prevalent underlying conditions, the researchers report in JAMA Dermatology.

Fifty of these patients (14%) received a systemic corticosteroid (SCS) for an initial cirAE, 192 (54%) did so for another indication and the remaining 116 (32%) did not get SCS.

Those who received a SCS for an initial cirAE had a significantly higher median rash severity and were significantly more likely to be hospitalized for cirAE management.

At 34%, infection rates were significantly higher in patients who received a SCS for an initial cirAE compared with those with no SCS exposures (20%). Most infections in both groups required systemic therapy, with 29% of the exposed group and 44% of those not exposed requiring hospitalization.

After adjusting for age, sex and exposures, the exposed group did not have significantly different progression-free survival (hazard ratio, 0.7; 95% confidence interval, 0.4 to 1.3) or overall survival (HR, 3.0; 95% CI, 0.4 to 1.3;).

“Despite the theoretical risk of SCS impeding the antitumor response, we found no association between SCS for an initial cirAE and progression-free survival or overall survival,” the researchers write.

However, added Dr. Chen, “we did find that patients who received systemic corticosteroids had an infectious complication more frequently than those that weren’t treated with steroids. Taken together, with the appropriate counseling, vigilance, and shared decision making, low-dose corticosteroids may be safe for our patients with ICI-induced skin toxicities. Future work can help further study these important questions as larger cohorts will be required to more adequately answer these important clinical questions.”

SOURCE: https://bit.ly/3azoMCq JAMA Dermatology, online April 14, 2021.

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  • Posted on April 28, 2021