Steroid Use Linked to Worse Outcomes in Lung Cancer

For individuals with non–small cell lung cancer (NSCLC) undergoing immunotherapy, a new study reveals that baseline corticosteroid use correlates with poorer results and less reliable biomarker data, prompting calls to re-evaluate steroid prescriptions.

Study Links Steroids to Diminished Immunotherapy Efficacy

Research featured in Cancer Research Communications indicates that patients with NSCLC who were using corticosteroids at the start of immune checkpoint inhibitor (ICI) treatment experienced significantly lower response rates, plus shorter progression-free and overall survival. The research was headed by **Fumito Ito**, an oncologist at the University of Southern California.

According to the American Cancer Society, NSCLC accounts for approximately 87% of all lung cancers. Survival rates remain low: for patients diagnosed between 2015 and 2021, the five-year survival rate hovered around 32%.

While ICIs like Keytruda and Opdivo have improved outcomes, steroids are often prescribed for symptom management. The new data suggests that such use before or during treatment blunts the effectiveness of immunotherapies.

Key Findings on Steroid Impact

The study found that even discontinuing steroids before ICI therapy led to better results than continuing their use. “The mere use of steroids was a more influential prognostic factor than the presence of brain metastases,” the study authors stated. Moreover, higher steroid doses correlated with worse outcomes.

Additionally, steroid use skewed blood-based immune markers, such as CX3CR1+ CD8+ T cell levels, complicating interpretation. Likewise, the typical association between a low neutrophil-to-lymphocyte ratio (NLR) and better prognosis disappeared in patients on steroids. These findings coincide with reports that nearly 40% of cancer patients are prescribed steroids, often for extended durations (Cureus, 2022).

Mouse Model Confirms Steroid Interference

Experiments involving tumor-bearing mice further validated these concerns. Steroids diminished the therapeutic benefits of anti–PD-L1 therapy and hampered T-cell development, even if steroids were stopped before treatment.

Looking Ahead

While acknowledging the study’s limitations, including a small sample size, the authors advocate for minimizing steroid use prior to ICI treatment. They propose that future research should investigate whether reducing or discontinuing steroids could improve clinical outcomes for these patients.