(227) The Impact of Concomitant High-Dose Corticosteroids and Immune Checkpoint Inhibitors in Patients with Brain Metastases Secondary to Lung Cancer or Melanoma

Poster Abstract:

Background:
Patients with lung cancer or melanoma metastasized to the brain may be on high-dose corticosteroids to alleviate intracranial pressure and/or cerebral edema. These patients may also receive immune checkpoint inhibitors (ICIs) for their primary disease. The impact of concomitant corticosteroids with ICI therapy currently remains inconsistent amongst the literature and may depend on several variables such as corticosteroid dose, duration and indication and type of ICI.

Objectives:
Primary objective: evaluate the effect of high-dose corticosteroids on progression-free survival (PFS) in patients receiving ICIs for the treatment of metastatic melanoma or lung cancer. Secondary objective: examine overall survival (OS) amongst this population.

Methods:
This is a retrospective chart review of 51 adult patients who received ICI therapy for lung cancer or melanoma with secondary brain metastases. The study consists of a high-dose steroid arm of 32 patients who received > 1 dose of ICI and > 1 dose of equivalent daily prednisone > 10mg and a control arm of 19 patients who received > 1 dose of ICI and > 1 dose of equivalent daily prednisone < 10mg (including 0 doses of steroids). ICD code C79.31 was utilized to identify patients diagnosed with secondary neoplasms of the brain. Disease status was captured every 2 months for 1 year following the start of concomitant therapy in the high-dose steroid arm and the start of ICI therapy in the control arm.

Results:
At 12 months, PFS was lower in the high-dose steroid arm (59%) compared to the control arm (74%). Both arms had 3 patient deaths within the evaluation period (15.8% in the control arm and 9.4% in the high-dose steroid arm). The control arm deaths occurred within 8 months of monitoring. Most patients who received high-dose steroids had an average prednisone dose of 20-29 mg/day throughout the duration of corticosteroid treatment. Most patients from both arms had documented disease progression at 2-4 months. The study sample included mostly PD-1 inhibitor utilization and the majority of patients in both arms had lung cancer.

Discussions/Conclusions
Our assessment of 48 patients showed a shorter PFS in patients with high dose steroid exposure. However, there was a higher mortality seen in the control arm which may have been associated with factors such as ICI regimens as later lines of therapy. Further research is needed to determine the impact of high dose steroids in other solid tumor diseases and concomitantly with each class of ICI.

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