論文No2115
Immune Checkpoint Inhibitor Outcomes for Patients With Non–Small-Cell Lung Cancer Receiving Baseline Corticosteroids for Palliative Versus Nonpalliative Indications
Biagio Ricciuti, MD1; Suzanne E. Dahlberg, PhD1; Anika Adeni1; Lynette M. Sholl, MD2; Mizuki Nishino, MD, MPH2; and Mark M. Awad, MD, PhD1
JCO, Volume 37, Issue 22, pp. 1927–1934, August 2019
<目的>
PD-1阻害薬で治療される非小細胞肺がん(NSCLC)患者で、ベースラインでステロイドを使用していると予後が悪い。
この因果関係、相関関係を検討するために、
我々はがんに関連した緩和ケア目的あるいはがんに関連しない用途で
ステロイドが処方されている患者で免疫療法を受けた群の予後を検討した。
<方法>
10mg以上のプレドニゾロンを処方され免疫療法を受けたNSCLC患者の予後を、
プレドニゾロン0-9mgを処方された群と比較した。
<結果>
650名のうち、93名(14.3%)が免疫療法開始時に10mg以上のプレドニゾロン処方を受けており、
無増悪生存期間中央値(mPFS)、全生存期間中央値(mOS)は9mg以下のプレドニゾロン投与群よりも有意に短かった
(mPFS, 2.0 v 3.4 months, respectively; P = .01; mOS, 4.9 v 11.2 months, respectively; P < .001)。
ステロイド処方理由別で解析すると、がんの緩和目的でプレドニゾロン投与された場合は
そうでない場合や9mg以下の投与の場合よりもmPFS, mOSが有意に短かった
(mPFS, 1.4 v 4.6 v 3.4 months, respectively; log-rank P < .001 across the three groups;
mOS, 2.2 v 10.7 v 11.2 months, respectively; log-rank P < .001 across the three groups)。
がんに関連しない理由でプレドニゾロンを投与されていた場合、10mg以上と9mg以下とでmPFS, mOSの有意な差はなかった。
<感想>
免疫療法(PD-1, PD-L1阻害薬)施行時にステロイドが処方されていた場合、
がんの緩和目的の場合は10mg以上で予後が悪くなったようです。
がんと関係ない理由でステロイドが処方されていた場合、PFS, OSに影響しなかったようです。
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【ふるさと納税】《農園直送》高級 シャインマスカット2〜3房(約1.3kg)〈秀品〉
10,000円
楽天 |
PURPOSE
Baseline use of corticosteroids is associated with poor outcomes in patients with non–small-cell lung cancer (NSCLC) treated with programmed cell death-1 axis inhibition. To approach the question of causation versus correlation for this association, we examined outcomes in patients treated with immunotherapy depending on whether corticosteroids were administered for cancer-related palliative reasons or cancer-unrelated indications.
PATIENTS AND METHODS
Clinical outcomes in patients with NSCLC treated with immunotherapy who received ≥ 10 mg prednisone were compared with outcomes in patients who received 0 to < 10 mg of prednisone.
RESULTS
Of 650 patients, the 93 patients (14.3%) who received ≥ 10 mg of prednisone at the time of immunotherapy initiation had shorter median progression-free survival (mPFS) and median overall survival (mOS) times than patients who received 0 to < 10 mg of prednisone (mPFS, 2.0 v 3.4 months, respectively; P = .01; mOS, 4.9 v 11.2 months, respectively; P < .001). When analyzed by reason for corticosteroid administration, mPFS and mOS were significantly shorter only among patients who received ≥ 10 mg prednisone for palliative indications compared with patients who received ≥ 10 mg prednisone for cancer-unrelated reasons and with patients receiving 0 to < 10 mg of prednisone (mPFS, 1.4 v 4.6 v 3.4 months, respectively; log-rank P < .001 across the three groups; mOS, 2.2 v 10.7 v 11.2 months, respectively; log-rank P < .001 across the three groups). There was no significant difference in mPFS or mOS in patients receiving ≥ 10 mg of prednisone for cancer-unrelated indications compared with patients receiving 0 to < 10 mg of prednisone.
CONCLUSION
Although patients with NSCLC treated with ≥ 10 mg of prednisone at the time of immunotherapy initiation have worse outcomes than patients who received 0 to < 10 mg of prednisone, this difference seems to be driven by a poor-prognosis subgroup of patients who receive corticosteroids for palliative indications.