Balancing immunotherapy and corticosteroids in cancer treatment: dilemma or paradox?

Corticosteroids are widely used to prevent and treat chemotherapy-induced nausea and vomiting (CINV) due to their pleiotropic biological effects. However, concerns have been raised about their immunosuppressive properties when combined with immunotherapy. Specifically, their potential impact on the efficacy of immunotherapy, mainly immune checkpoint inhibitors (ICIs), remains a subject of debate. This manuscript discusses the mechanisms by which corticosteroids mitigate CINV, the challenges associated with their concurrent use with immunotherapy, and emerging therapeutic strategies evaluating dexamethasone-free regimens. A careful balance must be struck in corticosteroid use to effectively manage CINV while optimizing the outcomes of immunotherapy.