在多瘤队列中,类固醇与免疫治疗疗效的负相关性:时间和剂量依赖
Víctor Albarrán1, Patricia Guerrero2, Coral García de Quevedo2
1Department of Medical Oncology, Ramon y Cajal University Hospital (Madrid), Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), Madrid, Spain. vicalbarranfernandez@gmail.com.
Cancer immunology, immunotherapy : CII
|August 2, 2024
概括
在早期免疫检查点抑制剂 (ICI) 治疗之前和期间使用类固醇可显著降低晚期固体瘤的应答率. 类固醇的影响取决于剂量,并在六个月后减弱,这表明ICI启动周围有一个关键窗口.
科学领域:
- 在瘤学瘤学.
- 免疫治疗是一种免疫疗法.
- 药理学 药理学是指药理学的学科.
背景情况:
- 以前的研究表明,类固醇可能会损害免疫检查点抑制剂 (ICI) 的有效性.
- 类固醇剂量和时间对ICI有效性的确切影响尚不清楚.
- 了解这种相互作用对于优化癌症免疫治疗方案至关重要.
研究的目的:
- 调查类固醇的时间和剂量对ICI疗效在先进的固体瘤的影响.
- 分析类固醇暴露与临床结果之间的关系,包括客观反应率 (ORR) 和生存率.
- 为了确定潜在的机制,如中性粒细胞与淋巴细胞比率 (NLR) 调节,底层的类固醇对ICI的影响.
主要方法:
- 对475名以单疗法ICI (2015-2022) 治疗的晚期固体瘤患者的回顾性分析.
- 收集有关免疫相关不良事件 (irAEs),临床结果和每日类固醇剂量 (普雷尼松毫克/公斤) 的数据.
- 分析累积的类固醇剂量及其与不同治疗周期的反应率和存活率的相关性.
主要成果:
- 与未服用类固醇患者相比,在ICI开始前30天内 (20.3%) 和前90天内 (25.7%) 接受类固醇的患者观察到较低的ORR.
- 在非响应者中发现了较高的平均类固醇剂量和累积剂量与疾病控制率 (DCR) 之间的反相关性.
- 六个月ICI治疗后的类固醇暴露不会对生存结果产生负面影响.
结论:
- 类固醇的使用,特别是在ICI开始时和前90天内,以剂量依赖的方式显著降低ICI的疗效.
- 类固醇对ICI有效性的负面影响似乎是时间敏感的,在治疗六个月后效果会减弱.
- NLR调节可能是一个潜在的机制;进一步的研究是有必要的,以确认发现和探索缓解策略.
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