ArticleCancer immunology, immunotherapy : CII2024
Negative association of steroids with immunotherapy efficacy in a multi-tumor cohort: time and dose-dependent.
Article in Cancer immunology, immunotherapy : CII, 2024. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 16 papers, 1 of them a synthesis that pooled it.
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The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
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Who cites it
16 citing papers in PubMed, 1 synthesis or guideline pooled it.
- Clinical Outcomes of Immunosuppressant Drugs in Patients Treated with Immune Checkpoint Inhibitors: A Systematic Review and Meta-Analysis.Medical principles and practice : international journal of the Kuwait University, Health Science Centre · 2026Pooled it
- Prednisolone modulates CD8⁺ and regulatory T-cell activity to dampen response to immune checkpoint inhibitor therapy in melanoma.Oncoimmunology · 2026Article
- Early and High-Dose Glucocorticoid Use and Survival in Advanced NSCLC Receiving Immune Checkpoint Inhibitors: A Multicenter Target Trial Emulation.Clinical pharmacology and therapeutics · 2026Observational
- Oral glucocorticoid treatment for checkpoint inhibitor-associated inflammatory arthritis does not affect cancer progression-free survival: a RADIOS Registry study.Annals of the rheumatic diseases · 2026Observational
- Differential effects of prior versus concomitant Steroid and Antibiotic Treatment on Immunotherapy Efficacy - A Pooled Analysis of the RAMONA, INTEGA, OPTIM, ELDORANDO, FORCE, TITAN-RCC and TITAN-TCC Trials of the German AIO Study Group.British journal of cancer · 2026Article
- Atezolizumab in combination with neoadjuvant chemotherapy and interval cytoreductive surgery for patients with newly diagnosed advanced-stage epithelial ovarian cancer: the AdORN study.Gynecologic oncology · 2026Article
- Neutralization of acyl-CoA-binding protein attenuates glucocorticoid-mediated suppression of cancer immunosurveillance.Proceedings of the National Academy of Sciences of the United States of America · 2026Article
- Utilization of Steroid Sparing Agents for Immune-Related Adverse Events (irAEs): Management Strategies and Considerations.Current oncology reports · 2026Review
- Immuno-oncologyDupilumab for bullous pemphigoid related to immune checkpoint inhibitors: a retrospective case series.The oncologist · 2025Article
- Article
- The Mitigating Effect of Combined Glucocorticoids with Immune Checkpoint Inhibitors on Lymphocyte Activation Gene-3 and Programmed Death-1 Expression.European journal of immunology · 2025Article
- Steroid hormones as modulators of anti-tumoural immunity.Nature reviews. Endocrinology · 2025Review
- Stereotactic radiosurgery for patients with brain metastases: current principles, expanding indications and opportunities for multidisciplinary care.Nature reviews. Clinical oncology · 2025Review
- The effect of baseline versus early glucocorticoid use on immune checkpoint inhibitor efficacy in patients with advanced NSCLC.Frontiers in oncology · 2025Article
- Review
- Investigating the relationship between vitamin D levels and immune-mediated colitis.Annals of gastroenterologyArticle
Corrections and comments
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Authors and funding
26 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
Previous studies have suggested a negative impact of steroids on the efficacy of immune checkpoint inhibitors (ICI), but how this effect is modulated by the dosage and time of administration is yet to be clarified. We have performed a retrospective analysis of 475 patients with advanced solid tumors treated with ICI as monotherapy from 2015 to 2022. Data regarding immune-related adverse events (irAEs) and clinical outcomes were collected. For each patient, the daily steroid dose (in mg/kg of prednisone) was registered until disease progression or death. The impact of cumulative doses on response rates and survival outcomes was analyzed within different periods. The objective response rate (ORR) was significantly lower among patients exposed to steroids within 30 days before the first cycle of ICI (C1) (20.3% vs. 36.7%, p < 0.01) and within the first 90 days of treatment (25.7% vs. 37.7%, p = 0.01). This negative association was confirmed by multivariable analysis. Higher mean steroid doses were observed among non-responders, and cumulative doses were inversely correlated with the disease control rate (DCR) around ICI initiation. Remarkably, poorer outcomes were observed even in patients belonging to the lowest dose quartile compared to the steroid-naïve population. The exposure to steroids after 6 months of ICI was not associated with worse survival outcomes. Our results suggest that the potential impact of steroids on ICI efficacy may be time-dependent, prevailing around ICI initiation, and dose-dependent, with modulation of neutrophil-to-lymphocyte ratio as a possible underlying mechanism.
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