TY - JOUR
T1 - Impact of corticosteroid therapy on the outcomes of hepatocellular carcinoma treated with immune checkpoint inhibitor therapy
AU - Pinato, David J.
AU - Kaseb, Ahmed
AU - Wang, Yinghong
AU - Saeed, Anwaar
AU - Szafron, David
AU - Jun, Tomi
AU - Dharmapuri, Sirish
AU - Naqash, Abdul Rafeh
AU - Muzaffar, Mahvish
AU - Navaid, Musharraf
AU - Khan, Uqba
AU - Lee, Chiehju
AU - Bulumulle, Anushi
AU - Yu, Bo
AU - Paul, Sonal
AU - Fessas, Petros
AU - Nimkar, Neil
AU - Bettinger, Dominik
AU - Hildebrand, Hannah
AU - Pressiani, Tiziana
AU - Abugabal, Yehia I.
AU - Personeni, Nicola
AU - Huang, Yi Hsiang
AU - Lozano-Kuehne, Jingky
AU - Rimassa, Lorenza
AU - Ang, Celina
AU - Marron, Thomas U.
N1 - Publisher Copyright:
© BMJ Publishing Group Limited 2020
PY - 2020/10/7
Y1 - 2020/10/7
N2 - The impact of corticosteroid therapy (CT) on efficacy of immune checkpoint inhibitors (ICI) is undefined in hepatocellular carcinoma (HCC). We evaluated whether CT administered at baseline (bCT) or concurrently with ICI (cCT) influences overall (OS), progression-free survival (PFS) and overall response rates (ORR) in 341 patients collected across 3 continents. Of 304 eligible patients, 78 (26%) received >10 mg prednisone equivalent daily either as bCT (n=14, 5%) or cCT (n=64, 21%). Indications for CT included procedure/prophylaxis (n=37, 47%), management of immune-related adverse event (n=27, 35%), cancer-related symptoms (n=8, 10%) or comorbidities (n=6, 8%). Neither overall CT, bCT nor cCT predicted for worse OS, PFS nor ORR in univariable and multivariable analyses (p>0.05). CT for cancer-related indications predicted for shorter PFS (p<0.001) and was associated with refractoriness to ICI (75% vs 33%, p=0.05) compared with cancer-unrelated indications. This is the first study to demonstrate that neither bCT nor cCT influence response and OS following ICI in HCC. Worse outcomes in CT recipients for cancer-related indications appear driven by the poor prognosis associated with symptomatic HCC.
AB - The impact of corticosteroid therapy (CT) on efficacy of immune checkpoint inhibitors (ICI) is undefined in hepatocellular carcinoma (HCC). We evaluated whether CT administered at baseline (bCT) or concurrently with ICI (cCT) influences overall (OS), progression-free survival (PFS) and overall response rates (ORR) in 341 patients collected across 3 continents. Of 304 eligible patients, 78 (26%) received >10 mg prednisone equivalent daily either as bCT (n=14, 5%) or cCT (n=64, 21%). Indications for CT included procedure/prophylaxis (n=37, 47%), management of immune-related adverse event (n=27, 35%), cancer-related symptoms (n=8, 10%) or comorbidities (n=6, 8%). Neither overall CT, bCT nor cCT predicted for worse OS, PFS nor ORR in univariable and multivariable analyses (p>0.05). CT for cancer-related indications predicted for shorter PFS (p<0.001) and was associated with refractoriness to ICI (75% vs 33%, p=0.05) compared with cancer-unrelated indications. This is the first study to demonstrate that neither bCT nor cCT influence response and OS following ICI in HCC. Worse outcomes in CT recipients for cancer-related indications appear driven by the poor prognosis associated with symptomatic HCC.
KW - immunomodulation
KW - liver neoplasms
UR - http://www.scopus.com/inward/record.url?scp=85092549960&partnerID=8YFLogxK
U2 - 10.1136/jitc-2020-000726
DO - 10.1136/jitc-2020-000726
M3 - Article
SN - 2051-1426
VL - 8
JO - Journal for ImmunoTherapy of Cancer
JF - Journal for ImmunoTherapy of Cancer
IS - 2
M1 - e000726
ER -
