Abstract
Thanks to their anti-inflammatory, anti-oedema, and anti-allergy properties, glucocorticoids are among the most widely prescribed drugs in patients with cancer. The indications for glucocorticoid use are very wide and varied in the context of cancer and include the symptomatic management of cancer-related symptoms (compression, pain, oedema, altered general state) but also prevention or treatment of common side effects of anti-cancer therapies (nausea, allergies, etc.) or immune-related adverse events (irAE). In this review, we first give an overview of the different clinical situations where glucocorticoids are used in oncology. Next, we describe the current state of knowledge regarding the effects of these molecules on immune response, in particular anti-tumour response, and we summarize available data evaluating how these effects may interfere with the efficacy of immunotherapy using immune checkpoint inhibitors.
Highlights
The Historical Role of Glucocorticoids in Cancer Treatment Thanks to their anti-inflammatory, anti-oedema, and anti-allergy properties, glucocorticoids (GCs) are among the most widely prescribed drug classes in patients with cancer
An improved understanding of the impact of GCs in the setting of immunotherapy would make it possible to better manage their use in certain situations that are frequent in cancer patients, such as to treat immune-mediated adverse events, to manage cancer-related symptoms, or for prophylaxis of adverse effects of chemotherapy associated with immunotherapy (Figure 4)
These so-called “immune-related adverse events” arise from the mechanism of action of immune checkpoint inhibitors (ICI), notably by reactivation of exhausted T cells, which can lead to a loss of self-tolerance and to the onset of certain auto-immune manifestations [117]
Summary
The Historical Role of Glucocorticoids in Cancer Treatment Thanks to their anti-inflammatory, anti-oedema, and anti-allergy properties, glucocorticoids (GCs) are among the most widely prescribed drug classes in patients with cancer. Improvements in our understanding of their effects on immunity have raised the legitimate question of the impact of GCs use on cancer progression, especially since immunotherapy has emerged as a major treatment at the advanced stage in numerous forms of cancer. We give an overview of the main current indications for GCs in patients with cancer. We discuss current biological knowledge of the effects of GCs on the main components of the immune response (especially the components involved in anti-tumour immune response). In light of recently published clinical findings, we review the possible impact of GCs on the efficacy of immunotherapy with immune checkpoint inhibitors (ICI) in patients receiving these two types of treatment. GCs have even been used to counter adverse, immune-mediated effects in patients treated by immunotherapy
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