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Abstract
Steroids are often utilized to manage patients with non-small cell lung cancer brain metastases (NSCLCBM). Steroids and elevated neutrophil-to-lymphocyte ratio (NLR) have been associated with decreased overall survival (OS) in patients treated with immune checkpoint inhibitors (ICI). We retrospectively investigated patients treated with ICI after the diagnosis of NSCLCBM at a single tertiary care institution examing the impact of steroids and NLR. Overall survival (OS) and intracranial progression-free survival (PFS) were analyzed. 171 patients treated with ICI for NSCLCBM were included. Thirty-six received steroids within 30 days of the start of ICI, and 53 patients had an NLR ≥ 5 before the start of ICI. Upfront steroids was associated with decreased OS on multivariable analysis (median OS 10.5 vs. 17.9 months, p = .03) and intracranial PFS (5.0 vs. 8.7 months, p = .045). NLR ≥ 5 was indicative of worse OS (10.5 vs. 18.4 months, p = .04) but not intracranial PFS (7.2 vs. 7.7 months, p = .61). When NLR and upfront steroids are modeled together, there is a strong interaction (p = .0008) indicating that the impact of steroids depended on the patient’s NLR. In a subgroup analysis, only in patients with NLR < 4 was there a significant difference in OS with upfront steroids (26.1 vs. 15.6 months, p = .032). The impact of steroids on the efficacy of ICI in patients with NSCLCBM is dependent on the patient's NLR underscoring its importance in these patients. Patients with a low NLR, steroid use decreases the efficacy of ICI. These results can inform clinicians about the impact of steroids in patients treated with ICI.
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1 Cleveland Clinic Lerner College of Medicine At Case Western Reserve University, Cleveland, USA (GRID:grid.254293.b) (ISNI:0000 0004 0435 0569)
2 Foedtert and Medical College of Wisconsin, Milwaukee, USA (GRID:grid.30760.32) (ISNI:0000 0001 2111 8460)
3 University of Louisville, Department of Neurological Surgery, Louisville, USA (GRID:grid.266623.5) (ISNI:0000 0001 2113 1622)
4 Taussig Cancer Institute, Cleveland Clinic, Rosa Ella Burkhart Brain Tumor and Neuro-Oncology Center, Cleveland, USA (GRID:grid.239578.2) (ISNI:0000 0001 0675 4725); Neurological Institute, Cleveland Clinic, Department of Neurological Surgery, Cleveland, USA (GRID:grid.239578.2) (ISNI:0000 0001 0675 4725)
5 Taussig Cancer Institute, Cleveland Clinic, Rosa Ella Burkhart Brain Tumor and Neuro-Oncology Center, Cleveland, USA (GRID:grid.239578.2) (ISNI:0000 0001 0675 4725)
6 Cleveland Clinic Florida, Department of Neurological Surgery, Weston, USA (GRID:grid.418628.1) (ISNI:0000 0004 0481 997X)
7 Summa Health, Department of Medicine, Akron, USA (GRID:grid.416711.4) (ISNI:0000 0004 0367 457X)
8 Taussig Cancer Institute, Cleveland Clinic, Department of Medical Oncology, Cleveland, USA (GRID:grid.239578.2) (ISNI:0000 0001 0675 4725)
9 Cleveland Clinic Lerner College of Medicine At Case Western Reserve University, Cleveland, USA (GRID:grid.254293.b) (ISNI:0000 0004 0435 0569); Taussig Cancer Institute, Cleveland Clinic, Rosa Ella Burkhart Brain Tumor and Neuro-Oncology Center, Cleveland, USA (GRID:grid.239578.2) (ISNI:0000 0001 0675 4725); Neurological Institute, Cleveland Clinic, Department of Neurological Surgery, Cleveland, USA (GRID:grid.239578.2) (ISNI:0000 0001 0675 4725)
10 Taussig Cancer Institute, Cleveland Clinic, Rosa Ella Burkhart Brain Tumor and Neuro-Oncology Center, Cleveland, USA (GRID:grid.239578.2) (ISNI:0000 0001 0675 4725); Taussig Cancer Institute, Cleveland Clinic, Department of Radiation Oncology, Cleveland, USA (GRID:grid.239578.2) (ISNI:0000 0001 0675 4725)
11 Cleveland Clinic Lerner College of Medicine At Case Western Reserve University, Cleveland, USA (GRID:grid.254293.b) (ISNI:0000 0004 0435 0569); Lerner Research Institute, Cleveland Clinic, Department of Quantitative Health Sciences, Cleveland, USA (GRID:grid.239578.2) (ISNI:0000 0001 0675 4725)
12 Miami Cancer Institute, Department of Medical Oncology, Miami, USA (GRID:grid.418212.c) (ISNI:0000 0004 0465 0852)