皮质类固醇是否会影响恶性瘤免疫治疗的有效性? - 进行系统审查
Yoni Byron1, Sonya Yegorova-Lee2, Martin Tio3
1Alan Walker Cancer Centre, Royal Darwin Hospital, Darwin, 0810, Northern Territory, Australia.
为非癌症原因服用的皮质类固醇不会显著影响癌症患者的免疫治疗反应或存活率. 这次系统性审查发现,在排除息性指示时,对治疗结果没有不良影响.
科学领域:
- 在瘤学瘤学.
- 免疫学 免疫学 免疫学
- 药理学 药理学是指药理学的学科.
背景情况:
- 早期研究表明,皮质类固醇可能会降低免疫治疗的益处.
- 本系统性审查涉及皮质类固醇对癌症患者免疫治疗疗效的影响.
- 该研究特别调整了用于息治疗的皮质类固醇.
研究的目的:
- 评估皮质类固醇对癌症患者免疫治疗结果的影响.
- 为了区分用于非癌症指示的皮质类固醇与息治疗治疗的影响.
- 综合关于皮质类固醇使用和免疫治疗反应的证据.
主要方法:
- 来自PubMed,Embase和Medline的研究的系统审查和元分析.
- 包括的研究比较了接受皮质类固醇治疗的患者的免疫疗法反应/存活率,以治疗非癌症症状,而不是对照.
- 排除了仅针对免疫相关不良事件 (irAE) 的皮质类固醇的研究. 计算了聚合赔率和危险比率.
主要成果:
- 八项研究被纳入了元分析.
- 对于非癌症指标的皮质类固醇,对整体反应率没有统计学上显著的影响 (OR 1.01).
- 没有观察到对无进展生存时间 (HR 0.87) 或整体生存时间 (HR 0.79) 的显著影响.
结论:
- 对于非癌症指标的皮质类固醇似乎不会对免疫疗法反应或生存产生负面影响.
- 结果表明,缓解性皮质类固醇使用的混效应被成功减轻了.
- 限制包括回顾性研究设计,小样本大小,以及在某些研究中包含irAE的潜在偏见.
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