Outcomes Better With Immune-Related Toxicities, Steroids Okay for Management

New York—Immune-related adverse events that occur in response to treatment with immunotherapies do not necessarily lead to worse outcomes in patients with cancer, and can be controlled with steroids, according to a presentation made at the 23rd Annual Perspectives in Thoracic Oncology meeting,

Lyudmila Bazhenova, MD, Clinical Professor of Medicine, UC San Diego Moores Cancer Center, began her presentation on the monitoring, management, and mitigation of immune-related adverse events by posing a series of questions, including whether it is detrimental to use steroids for management of immune-related adverse events, and whether patients who have these responses have better outcomes.

A Unique Toxicity Profile

“Despite the significant benefits of immunotherapies, they have a unique toxicity profile. Immune-related adverse events arise from tipping the balance of autoimmunity,” she said.

Some unique characteristics of immune-related adverse events include the ability to reverse them if they are treated in a timely manner; their tendency to progress to a more severe state when left untreated; and that they can occur within days of an initial immunotherapy dose, after several months of therapy, or following discontinuation of therapy.

These unique responses, however, have been shown to correlate with a better prognosis.

Citing multiple studies, Dr Bazhenova told attendees that patients who have immune-related adverse events have been shown to have improved outcomes in the melanoma (JAMA Oncol. 2018;4[3]:374-378) and non–small-cell lung cancer (J Clin Oncol. 2017;36[suppl 15]:9084) settings.

Use of Steroids for Management

She also referred to a few studies of patients with immune-related adverse events who received treatment with ipilimumab or nivolumab.

Among patients who received ipilimumab (n = 294), 254 (85%) had immune-related adverse events (J Clin Oncol. 2015;33[28]:3193-3198). A total of 103 (35%) of these patients required treatment with corticosteroids, and 29 (10%) received anti–TNF therapy.

“There was no outcome differences for patients requiring corticosteroids and those not requiring immunosuppressive therapy,” Dr Bazhenova said.

Similar response rates were seen in a separate study of 576 patients being treated with nivolumab, regardless of whether they also received immune-modulating agents (J Clin Oncol. 2017;35[7]:785-792).

“Steroids used to control immune-related adverse events are not detrimental,” she stressed.—Hina Khaliq