A large multicenter cohort study reveals that systemic glucocorticoid immunosuppression (gsISP) near immune checkpoint inhibitor (ICI) initiation may reduce overall survival in cancer patients. Researchers analyzed data from 39,258 patients across two cohorts, including Massachusetts General Hospital, Brigham and Women's Hospital, and Dana-Farber Cancer Institute.
The study found that patients exposed to gsISP within one month of starting ICIs had nearly half the survival time of those not receiving steroids. Prednisone-equivalent doses over 60 mg per day were linked to a 37% reduction in survival, and treatment lasting more than seven days was associated with a 33% shorter overall survival. These results were independently validated in an external cohort.
The association persisted regardless of the reason for steroid use, suggesting immunosuppression itself may hinder ICI efficacy. Researchers urge clinicians to minimize steroid exposure near treatment initiation, using the lowest effective dose for the shortest possible duration.