Hitting the sweet spot: optimal use of corticosteroids for immune checkpoint inhibitor side-effects

Since the approval of ipilimumab for the treatment of melanoma in 2011, immune checkpoint inhibitors have changed the treatment landscape for solid and haematological malignancies, 1 Esfahani K Roudaia L Buhlaiga N Del Rincon SV Papneja N Miller Jr, WH A review of cancer immunotherapy: from the past, to the present, to the future. Curr Oncol. 2020; 27: S87-S97 Crossref PubMed Scopus (224) Google Scholar and almost half of patients with cancer might be eligible for treatment with these drugs. 2 Haslam A Prasad V Estimation of the percentage of US patients with cancer who are eligible for and respond to checkpoint inhibitor immunotherapy drugs. JAMA Netw Open. 2019; 2: e192535 Crossref PubMed Scopus (470) Google Scholar A substantial number of those treated with immune checkpoint inhibitors will have so-called immune-related adverse events: rates of such adverse events range from approximately 15% for PD-1 and PD-L1 inhibitors to approximately 35% for CTLA-4 antibodies and approximately 55% for the combination of CTLA-4 and PD-1 antibodies. 3 Arnaud-Coffin P Maillet D Gan HK et al. A systematic review of adverse events in randomized trials assessing immune checkpoint inhibitors. Int J Cancer. 2019; 145: 639-648 Crossref PubMed Scopus (87) Google Scholar Interestingly, immune-related adverse events might be a surrogate for tumour control 4 Schadendorf D Wolchok JD Hodi FS et al. Efficacy and safety outcomes in patients with advanced melanoma who discontinued treatment with nivolumab and ipilimumab because of adverse events: a pooled analysis of randomized phase II and III trials. J Clin Oncol. 2017; 35: 3807-3814 Crossref PubMed Scopus (266) Google Scholar and improved outcomes. 5 Eggermont AMM Kicinski M Blank CU et al. Association between immune-related adverse events and recurrence-free survival among patients with stage III melanoma randomized to receive pembrolizumab or placebo: a secondary analysis of a randomized clinical trial. JAMA Oncol. 2020; 6: 519-527 Crossref PubMed Scopus (171) Google Scholar , 6 Zhou X Yao Z Yang H Liang N Zhang X Zhang F Are immune-related adverse events associated with the efficacy of immune checkpoint inhibitors in patients with cancer? A systematic review and meta-analysis. BMC Med. 2020; 18: 87 Crossref PubMed Scopus (96) Google Scholar