Revisiting the use of steroids in oncology

Glucocorticoids are cornerstone agents in oncology due to their potent anti-inflammatory, immunosuppressive, and antitumor properties. Glucocorticoids exert direct cytotoxic effects in hematologic malignancies such as lymphomas, acute lymphoblastic leukemia, and multiple myeloma by inducing apoptosis. Their role is primarily supportive in solid tumors, although glucocorticoid receptor signaling may influence tumor progression in cancers like breast and prostate. They are routinely employed to reduce cerebral edema, manage chemotherapy-induced nausea and vomiting, relieve spinal cord compression, and prevent hypersensitivity reactions to agents such as taxanes and monoclonal antibodies. In prostate cancer, they aid in managing adrenal suppression linked to androgen deprivation therapy. However, routine premedication with glucocorticoids before immunotherapy may impair treatment efficacy and should be avoided unless managing immune-related adverse events. Long-term use is associated with significant toxicities, including osteoporosis, metabolic complications, and increased susceptibility to infections. Judicious use-employing the lowest effective dose for the shortest necessary duration-is crucial to strike a balance between therapeutic benefit and harm. Despite their risks, glucocorticoids remain indispensable in oncology, highlighting the need for personalized and evidence-guided approaches to their use. This narrative review outlines their mechanisms, clinical applications, associated risks, and evolving considerations in cancer care.