Impact of baseline steroids on efficacy of programmed cell death-1 (PD-1) and programmed death-ligand 1 (PD-L1) blockade in patients with advanced non-small cell lung cancer

Immune checkpoint inhibitors (ICI) have become part of the standard of care of patients with locally advanced and advanced non-small cell lung cancer (NSCLC) (1). Corticosteroids are broadly used as premedication for most chemotherapy regimens and are frequently used to alleviate pain or dyspnea, to stimulate appetite, or to palliate symptoms associated with brain or epidural metastases. However, corticosteroids have anti-inflammatory and immunosuppressive effects that act over both innate and adaptive immunity. Based on this, patients treated with corticosteroids at doses equal to or higher than 10 mg/day of prednisone or equivalent have been systematically excluded from clinical trials of ICI.