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Clinical Outcomes of Immunosuppressant Drugs in Patients Treated with Immune Checkpoint Inhibitors: A Systematic

Faizah M Alotaibi1,2,3, Sara M Alrowaydan4,5, Lamia K Alshamlani4,5

  • 1College of Science and Health Professions, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia, alotaibifai@ksau-hs.edu.sa.

Medical Principles and Practice : International Journal of the Kuwait University, Health Science Centre
|June 18, 2026
PubMed
Abstract

Insights

Using immunosuppressant drugs (ISDs) during immune checkpoint inhibitor (ICI) therapy is linked to worse survival outcomes for cancer patients. This includes reduced overall survival (OS) and progression-free survival (PFS), particularly in non-small-cell lung cancer.

Area of Science:

  • Oncology
  • Immunology
  • Pharmacology

Background:

  • Immune checkpoint inhibitors (ICIs) have revolutionized cancer treatment.
  • The use of immunosuppressant drugs (ISDs) concurrently with ICIs is common for managing immune-related adverse events (irAEs).
  • The impact of ISDs on ICI efficacy remains a critical clinical question.

Purpose of the Study:

  • To systematically evaluate the impact of immunosuppressant drugs (ISDs) on clinical outcomes in cancer patients treated with immune checkpoint inhibitors (ICIs).

Main Methods:

  • A systematic review and meta-analysis of eligible studies.
  • Included adult cancer patients receiving ICIs, stratified by ISD use.
  • Analyzed overall survival (OS) and progression-free survival (PFS) data.

Main Results:

  • 33 studies with 34,063 patients were analyzed.
  • ISD use during ICI therapy was associated with significantly worse OS (HR=1.31) and PFS (HR=1.39).
  • Subgroup analysis revealed reduced OS in non-small-cell lung cancer patients using ISDs.

Conclusions:

  • ISD use is associated with reduced OS and PFS in cancer patients undergoing ICI treatment.
  • Findings underscore the need for precise management of irAEs to balance toxicity and therapeutic benefit.
  • Precision-based strategies are required to optimize outcomes in patients receiving concurrent ISD and ICI therapy.
Keywords:
CancerDrugsImmune-checkpoint inhibitorsImmunosuppressantSteroids

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