How to manage patients with corticosteroids in oncology in the era of immunotherapy?

Corticosteroids are among the most prescribed drugs in oncology. The indications range from cancer-related indications for refractory symptoms, anti-cancer effects mainly in hematology, supportive measures for cancer-specific treatments and more recently immune-related adverse events induced by modern immunotherapies. In oncological emergencies, corticosteroids are common first-line treatments because of their rapid effect and wide variety of actions. In the last 5 years, with the advance of immune checkpoint inhibitors, corticosteroids are becoming routinely used to manage immune-related adverse effects. Preclinical studies suggested that corticosteroid-induced immunosuppression might dampen the activity of immunotherapies. Prospective clinical studies show that corticosteroid use is a prognostic marker for the cancer outcome in metastatic setting but does not significantly alter the patient's response to immunotherapies per se. Here, we review the state of the art on corticosteroid use in oncology, with a focus on the drugs' potential impact on immunotherapy activity. The comprehensive pharmacological characteristics of corticosteroid drugs, clinical indications, modality of administration and associated precautions for use are discussed in this article.

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Conflict of interest statement Mihaela Aldea – nothing to disclose. Emeline Orillard – Honoraria: Astellas Janssen; Travels accommodations: Amgen Pfizer. Laura Mansi – nothing to disclose. Florian Scotte: Vifor pharma, MSD, BMS, Leo Pharma, Pierre Fabre Oncology, Bayer, Pfizer, Amgen, Helsinn, Roche, Tesaro, Mundi Pharma, Mylan, Tilray. Olivier Lambotte – BMS, MSD, Astra Zeneca, Incyte, Janssen, Gilead. Jean-Marie Michot – Principal/sub-Investigator of Clinical Trials for: Amgen, Astex, AstraZeneca, Medimmune, Roche, Sanofi, Xencor. Aurélien Marabelle – Principal/sub-Investigator of Clinical Trials for: Abbvie, Aduro biotech, Agios Pharmaceuticals, Amgen, Argen-X Bvba, Arno Therapeutics, Astex Pharmaceuticals, Astra Aeneca, Astra Zeneca Ab, Aveo, Bayer Healthcare Ag, Bbb Technologies Bv, Beigene, Bioalliance Pharma, Biontech Ag, Blueprint Medicines, Boehringer Ingelheim, Boston Pharmaceuticals, Inc, Bristol Myers Squibb, Bristol-Myers Squibb International Corporation, Ca, Celgene Corporation, Cephalon, Chugai Pharmaceutical Co, Clovis Oncology, Daiichi Sankyo, Debiopharm S.a, Eisai, Eli lilly, Exelixis, Forma, Gamamabs, Genentech, Inc, Gilead Sciences, Inc, Glaxosmithkline, Glenmark Pharmaceuticals, H3 Biomedicine, Inc, Hoffmann La Roche Ag, Incyte Corporation, Innate Pharma, Institut De Recherche Pierre Fabre, Iris Servier, Janssen Cilag, Janssen Research Foundation, Kura Oncology, Kyowa Kirin Pharm. Dev., Inc, Lilly France, Loxo Oncology, Lytix Biopharma As, Medimmune, Menarini Ricerche, Merck Kgaa, Merck Sharp & Dohme Chibret, Merrimack Pharmaceuticals, Merus, Millennium Pharmaceuticals, Nanobiotix, Nektar Therapeutics, Nerviano Medical Sciences, Novartis Pharma, Octimet Oncology Nv, Oncoethix, Oncomed, Oncopeptides, Onyx Therapeutics, Orion Pharma, Oryzon Genomics, Pfizer, Pharma Mar, Pierre Fabre Medicament, Plexxikon, Rigontec Gmbh, Roche, Sanofi Aventis, Sierra Oncology, Taiho Pharma, Tesaro, Tioma Therapeutics, Wyeth Pharmaceuticals France, Xencor, Y's TherapeuticsGustave Roussy Research Grants: Astrazeneca, BMS, Boehringer Ingelheim, Janssen Cilag, Merck, Novartis, Pfizer, Roche, Sanofi. Non-financial support (drug supplied) from Astra Zeneca, Bayer, BMS, Boehringer Ingelheim, Johnson & Johnson, Lilly, Medimmune, Merck serono, NH TherAGuiX, Pfizer, Roche. Member of Clinical Trial Scientific Committee for GSK, Astra Zeneca, Roche. Member of Data Safety and Monitoring Board for Oncovir, Inc. Scientific Advisory Boards for Innate Pharma, Merck Serono, eTheRNA, Lytix pharma, Kyowa Kirin Pharma, Bayer, Novartis, BMS, Symphogen, Genmab, Amgen, Biothera, Nektar, GSK, Oncovir, Pfizer, Seattle Genetics, Roche/Genentech, OSE immunotherapeutics, Transgene, Gritstone, Merck (MSD), Cerenis, Protagen, Partner Therapeutics, Servier, Sanofi, Pierre Fabre, Molecular Partners, IMCheck, Medicxi, Takeda, EISAI, HiFiBio, RedX, J&J, Gilead, Alkermes. Teaching/Speaker Bureau activities: Roche/Genentech, BMS, Merck (MSD), Merck Serono, Astra Zeneca/Medimmune, Amgen, Sanofi. Scientific & Medical Consulting for Roche, Pierre Fabre, Onxeo, EISAI, Bayer, Genticel, Rigontec, Daichii Sankyo, Sanofi, BioNTech, Corvus, GLG, Deerfield, Guidepoint Global, Edimark, System Analytics, imCheck, Sotio, Bioncotech, Molecular Partners, Pillar Partners, Boehringer Ingelheim, T3 Pharma, Servier, Takeda, GI Innovation. Non-Financial Support (travel expenses) from Astra Zeneca, BMS, Merck (MSD), Roche. Co-Founder & Share Holder of PEGASCY SAS (Gustave Roussy Spin Off for Drug Repositioning). Pre-Clinical and Clinical Research Grants (Institutional Funding): Merus, BMS, Boehringer Ingelheim, Transgene, Foundation MSD Avenir. Member of the following scholar societies: European Society for Medical Oncology (ESMO), American Society for Clinical Oncology (ASCO), American Association for Cancer Research (AACR), European Academy for Tumor Immunology (EATI). Founder and president of the French Society for Immunotherapy of Cancer (FITC). Member of the board of the Immuno-Oncology Group at the French Network of Comprehensive Cancer Centers (Unicancer). Member of the working group on rheumatic adverse events induced by cancer immunotherapies of the European League Against Rheumatoid Arthritis (EULAR). Supervisory Board Member of the Gustave Roussy Foundation. Member of the Steering Committee of the Immuno-Oncology Task Force at Unicancer. Member of the editorial boards of the European Journal of Cancer and ESMO IO Tech.