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Steroids and ICI Efficacy — SCE Medical Oncology MCQ

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ModerateLung CancerSteroids and ICI EfficacySCE Medical Oncology

A 70-year-old man with NSCLC on pembrolizumab develops a new autoimmune haemolytic anaemia. His oncologist prescribes prednisolone 1 mg/kg but wants to minimise steroid duration. What is the concern about prolonged high-dose corticosteroids during ICI treatment?

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Correct answer: B — Prolonged high-dose corticosteroids (>10 mg prednisolone equivalent for >2-4 weeks) may reduce ICI anti-tumour efficacy by suppressing T-cell function — steroids should be tapered to ≤10 mg prednisolone as quickly as irAE control allows

The relationship between corticosteroids and ICI efficacy is nuanced. Studies show: (1) baseline steroids >10 mg prednisolone for cancer symptoms (e.g. brain mets) associate with worse ICI outcomes (likely confounded by poor prognosis), (2) steroids for irAE management do NOT appear to negate ICI benefit in most analyses (the irAE itself is a positive prognostic marker), (3) prolonged high-dose steroids may impair T-cell function. Practical approach: use adequate steroids to control irAEs but taper to ≤10 mg prednisolone as quickly as safely possible.

Reference: ESMO 2024 irAE Management; Ricciuti et al JCO 2019; Faje et al Ann Oncol 2018