TY - JOUR
T1 - The combined use of steroids and immune checkpoint inhibitors in brain metastasis patients
T2 - a systematic review and meta-analysis
AU - Jessurun, Charissa A C
AU - Hulsbergen, Alexander F C
AU - de Wit, Anouk E
AU - Tewarie, Ishaan A
AU - Snijders, Tom J
AU - Verhoeff, Joost J C
AU - Phillips, John
AU - Reardon, David A
AU - Mekary, Rania A
AU - Broekman, Marike L D
N1 - Publisher Copyright:
© 2021 The Author(s) 2021.
PY - 2021/8/1
Y1 - 2021/8/1
N2 - BACKGROUND: Immune checkpoint inhibitors (ICI) have been a breakthrough for selected cancer patients, including those with brain metastases (BMs). Likewise, steroids have been an integral component of symptomatic management of BM patients. However, clinical evidence on the interaction between ICI and steroids in BM patients is conflicting and has not adequately been summarized thus far. Hence, the aim of this study was to perform a systematic literature review and meta-analysis on the association between steroid use and overall survival (OS) in BM patients receiving ICI.METHODS: A systematic literature search was performed. Pooled effect estimates were calculated using random-effects models across included studies.RESULTS: After screening 1145 abstracts, 15 observational studies were included. Fourteen studies reported sufficient data for meta-analysis, comprising 1102 BM patients of which 32.1% received steroids. In the steroid group, median OS ranged from 2.9 to 10.2 months. In the nonsteroid group, median OS ranged from 4.9 to 25.1 months. Pooled results demonstrated significantly worse OS (HR = 1.84, 95% CI 1.22-2.77) and systemic progression-free survival (PFS; HR = 2.00, 95% CI 1.37-2.91) in the steroid group. Stratified analysis showed a consistent effect across the melanoma subgroup; not in the lung cancer subgroup. No significant association was shown between steroid use and intracranial PFS (HR = 1.31, 95% CI 0.42-4.07).CONCLUSIONS: Administration of steroids was associated with significantly worse OS and PFS in BM patients receiving ICI. Further research on dose, timing, and duration of steroids is needed to elucidate the cause of this association and optimize outcomes in BM patients receiving ICI.
AB - BACKGROUND: Immune checkpoint inhibitors (ICI) have been a breakthrough for selected cancer patients, including those with brain metastases (BMs). Likewise, steroids have been an integral component of symptomatic management of BM patients. However, clinical evidence on the interaction between ICI and steroids in BM patients is conflicting and has not adequately been summarized thus far. Hence, the aim of this study was to perform a systematic literature review and meta-analysis on the association between steroid use and overall survival (OS) in BM patients receiving ICI.METHODS: A systematic literature search was performed. Pooled effect estimates were calculated using random-effects models across included studies.RESULTS: After screening 1145 abstracts, 15 observational studies were included. Fourteen studies reported sufficient data for meta-analysis, comprising 1102 BM patients of which 32.1% received steroids. In the steroid group, median OS ranged from 2.9 to 10.2 months. In the nonsteroid group, median OS ranged from 4.9 to 25.1 months. Pooled results demonstrated significantly worse OS (HR = 1.84, 95% CI 1.22-2.77) and systemic progression-free survival (PFS; HR = 2.00, 95% CI 1.37-2.91) in the steroid group. Stratified analysis showed a consistent effect across the melanoma subgroup; not in the lung cancer subgroup. No significant association was shown between steroid use and intracranial PFS (HR = 1.31, 95% CI 0.42-4.07).CONCLUSIONS: Administration of steroids was associated with significantly worse OS and PFS in BM patients receiving ICI. Further research on dose, timing, and duration of steroids is needed to elucidate the cause of this association and optimize outcomes in BM patients receiving ICI.
KW - brain metastases
KW - immune checkpoint inhibitors
KW - meta-analysis
KW - steroids
KW - survival
UR - http://www.scopus.com/inward/record.url?scp=85113293418&partnerID=8YFLogxK
U2 - 10.1093/neuonc/noab046
DO - 10.1093/neuonc/noab046
M3 - Review article
C2 - 33631792
SN - 1522-8517
VL - 23
SP - 1261
EP - 1272
JO - Neuro-Oncology
JF - Neuro-Oncology
IS - 8
ER -