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Impact of corticosteroid use on outcomes of non–small‐cell lung cancer patients treated with immune checkpoint inhibitors: A systematic review and meta‐analysis
Author(s) -
Zhang Hongchuan,
Li Xuemei,
Huang Xingliang,
Li Junfeng,
Ma Hong,
Zeng Rui
Publication year - 2021
Publication title -
journal of clinical pharmacy and therapeutics
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.622
H-Index - 73
eISSN - 1365-2710
pISSN - 0269-4727
DOI - 10.1111/jcpt.13469
Subject(s) - medicine , nivolumab , pembrolizumab , meta analysis , odds ratio , cochrane library , lung cancer , medline , oncology , confidence interval , publication bias , cancer , immunotherapy , political science , law
What is known and objective Administration of corticosteroids to immune checkpoint inhibitors (ICI)–treated patients has raised concerns due to doubts about ICIs' efficacy under those conditions. Hence, we reviewed studies comparing overall and progression‐free survival (OS and PFS) outcomes in patients with non–small‐cell lung carcinoma (NSCLC) treated with ICI and either with or without corticosteroids for any reason. Methods We searched the PubMed Central, Cochrane library, EMBASE and MEDLINE databases from inception until February 2021 for relevant publications. We used the Newcastle‐Ottawa scale to assess the quality of the identified studies. We used the published data to carry out a meta‐analysis with a random‐effects model and report pooled odds ratios (ORs) with 95% confidence intervals (CIs). Results We included data from 14 studies with 5461 participants in the meta‐analysis. Most studies were retrospective in nature and of low quality, and most of them were conducted in the USA and in European countries. Nivolumab is the most common ICI used in the included studies followed by pembrolizumab. We found that patients using corticosteroids had reduced OSs (pooled HR, 1.82; 95% CI, 1.51–2.18) and PFSs (pooled HR, 1.69; 95% CI, 1.41–2.04) than the patients not using corticosteroids. We identified significant heterogeneity and publication bias for both the outcomes. However, the sensitivity analysis revealed that the estimates were robust to the individual study effects. What is new and conclusion Our findings suggest that corticosteroids significantly reduce the OS and PFS of patients with NSCLC under ICI therapy. Hence, clinicians and oncologists should consider this information when prescribing corticosteroids for this target population.