Nivolumab and Steroids

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April 13, 2018 at 5:37 pm  #1294221    

sezz

My partner was diagnosed with stage 3b nsclc August 2015 and has been on Nivolumab for almost 12 months. Also has emphysema. In the past few months he has had shortness of breath after treatments. Dexamethazone helps relieve symptoms of breathlessness and fatigue.

The oncologist said it is ok to take steroids as needed, but another oncologist said reduces the effectiveness of the treatment. I got the impression they don’t really know because the drug is new. The idea was if it means you can continue with treatment, it’s better to take it.

Anyone have any information about this?

April 13, 2018 at 8:19 pm  #1294222    

onthemark

It looks like a situation where there are no conclusive results at the moment.

Quoting a meta-analysis paper from 2017 “Although limited, the reviewed data suggests that the concomitant administration of corticosteroidsand immune checkpoint inhibitors may not necessarily lead to poorer clinical outcomes.”

{Title: Concomitant use of corticosteroids and immune checkpoint inhibitors in
patients with hematologic or solid neoplasms: A systematic review
http://www.croh-online.com/article/S1040-8428(17)30397-9/pdf }

However, just because something hasn’t been measured conclusively yet doesn’t mean there is no effect. There just haven’t been controlled clinical trials to measure this specific outcome yet. So it is no wonder your doctors might disagree. If it were me I would try to take the smallest possible dosages of steroids as it seems intuitive there COULD BE at least a small negative relationship because of the way steroids dampen the immune system, whereas one wants to provoke an immune response with check point inhibitors.


10/2015 Chest xray found a nodule as part of a physical (no symptoms).
01/2016 Upper left lobe lingula preserving lobectomy stage 2b for 1.9 cm invasive adenocarcinoma with additional 2 mm AIS nodule found in pathology.
03-05/2016 Sixteen weeks of adjuvant cisplatin/vinorelbine.
07/2016 Durvalumab adjuvant clinical trial discontinued after 1st dose knocked out thyroid.
12/2016 Revised to stage 1b (due to VPI) after new guidelines for multifocal lepidic lung cancer.
07/2018 Next scan.

April 14, 2018 at 9:32 am  #1294224    
JimC Forum Moderator
JimC Forum Moderator

Hi sezz,

Onthemark provided some great information, and I would just add that in the context of immunotherapy for a patient with a pre-existing diagnosis of an autoimmune disease, steroid treatment is the therapy of choice when the autoimmune symptoms flare up. So immunotherapy and steroids are being used together, and not only am I not aware of studies showing that the efficacy of the immunotherapy is reduced in any significant way, I haven’t seen anecdotal reports of this posted here.

I think onthemark’s suggestion is sound: use the smallest possible dose/frequency/duration of steroid therapy sufficient to allow your partner to minimize symptoms and continue nivolumab therapy.

JimC
Forum moderator


Jul 2008 Wife Liz (51/never smoker) Dx Stage IV NSCLC EGFR exon 19
4 cycles Carbo/alimta, 65% shrinkage
Tarceva maintenance
Mar 2010 progression, added Alimta, stable
Sep 2010 multiple brain mets, WBR
Oct 2010 large pericardial effusion, tamponade
Jan 2011 progression, start abraxane
Jun 2011-New liver, brain mets, add Tarceva
Oct 2011-Dx Leptomeningeal carcinomatosis; pulsed Tarceva
At rest Nov 4 2011
Since then: http://cancergrace.org/blog/jim-and-lisa

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