Introduction: Checkpoint inhibitors augment the immune system's natural surveillance mechanisms and have increasing applications in NSCLC. Immunosuppressive corticosteroids are also frequently used in this population to treat unwanted inflammation. In view of this mechanistic opposition, we investigated the interaction between nivolumab and corticosteroids in patients with advanced NSCLC. Methods: A retrospective review of the charts of 210 patients with NSCLC who were treated with nivolumab at the Cleveland Clinic was performed. Use of systemic corticosteroids (equivalent to >10 mg of prednisone/d) during nivolumab therapy was associated with the objective outcomes number of nivolumab cycles and overall survival. Results: In all, 66 patients (31%) received concurrent systemic corticosteroids during nivolumab therapy. The most common indications included sequelae from active or treated brain metastases (27%) and chronic obstructive pulmonary disease or other respiratory disease (21%). For patients with early exposure to steroids (within the first 30 days of nivolumab therapy) (12% [n=25]), the median number of nivolumab cycles was 2, compared with five cycles in patients who were not exposed to corticosteroids (p = 0.002). The median overall survival time for patients who received steroids during the first 30 days was 4.3 months, compared with 11 months for patients who did not receive steroids (hazard ratio for death = 2.30, 95% confidence interval: CI 1.27–4.16, p = 0.006 in multivariate analysis). Conclusion: Nearly one‐third of patients with NSCLC treated with nivolumab were prescribed concurrent corticosteroids during the course of nivolumab therapy. Patients exposed to corticosteroids during the first cycle of nivolumab received fewer total cycles of nivolumab, suggesting decreased clinical benefit, and they had shorter overall survival.

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简报：接受纳武单抗治疗的晚期NSCLC患者早期全身性皮质类固醇的使用

简介：检查点抑制剂增强了免疫系统的自然监视机制，并在 NSCLC 中的应用越来越多。免疫抑制性皮质类固醇也经常用于该人群来治疗不需要的炎症。鉴于这种机制上的反对，我们调查了晚期 NSCLC 患者中纳武单抗和皮质类固醇之间的相互作用。方法：对 210 名在克利夫兰诊所接受纳武单抗治疗的 NSCLC 患者的图表进行了回顾性研究。在纳武单抗治疗期间使用全身皮质类固醇（相当于 >10 毫克泼尼松/天）与纳武单抗周期数和总生存期的客观结果相关。结果：总共 66 名患者 (31%) 在纳武单抗治疗期间同时接受全身皮质类固醇治疗。最常见的适应症包括活动性或治疗后脑转移的后遗症 (27%) 和慢性阻塞性肺病或其他呼吸系统疾病 (21%)。对于早期暴露于类固醇的患者（在 nivolumab 治疗的前 30 天内）（12% [n=25]），nivolumab 周期的中位数为 2，而未暴露于皮质类固醇的患者为 5 个周期（p = 0.002）。在前 30 天内接受类固醇治疗的患者的中位总生存时间为 4.3 个月，而未接受类固醇治疗的患者为 11 个月（死亡风险比 = 2.30，95% 置信区间：CI 1.27-4.16，p = 0.006 在多变量分析中）。结论：近三分之一接受纳武单抗治疗的 NSCLC 患者在纳武单抗治疗过程中同时服用了皮质类固醇。