Hatano Y et al. Support Care Cancer 2018; 26: 3979. doi:10.1007/s00520-018-4339-2

“Current management guidelines advise closely monitoring patients for signs and symptoms of interstitial lung disease or pneumonitis, immediately and actively managing all suspected events with corticosteroids, and delaying or stopping trastuzumab deruxtecan,” write the investigators.

The risk of developing high-grade irAEs requiring corticosteroids before the fifth cycle of treatment was significantly higher for patients carrying one or two versus no copies of the IL7 rs16906115 risk variant, with an odds ratio (OR) of 2.24.

Immune-mediated AEs were generally grade 1 or 2 in severity, tended to occur within the first 6 months of treatment, and resolved with corticosteroids.

Pembrolizumab therapy was discontinued and patients were successfully treated with oral prednisolone 40 mg/day that was tapered off over a month, although the older man required a second 3-month course of corticosteroids after symptoms recurred.

Interstitial lung disease/pneumonitis events were treated with a dose interruption or reduction, treatment discontinuation, corticosteroids, and supportive care.

The majority (82%) of the patients with radiologic SCC were given pre-emptive radiotherapy and 46% received corticosteroids.

The patients were treated for COVID-19 with antibiotics (48.7%), anticoagulants (37.2%), corticosteroids (33.4%); antiviral (18.9%) antimalarial (16.4%) and antifungal (2.6%) agents; and interleukin-6 inhibitors (3.1%).

In addition to recommendations for the management of organ-specific and systemic irAEs, they also provide “general recommendations that should be followed irrespective of affected organs,” including guidance by grade: Grade 1 – ICI therapy can be continued with close monitoring, except in the case of some neurologic, hematologic, and cardiologic toxicities; Grade 2 – Consider suspending ICIs, with the option to resume once symptoms resolve to grade 1 or below; Grade 3 – ICIs should be suspended and high-dose corticosteroids initiated, with rechallenge possible with caution; Grade 4 – Such toxicities warrant permanent discontinuation, except in the case of endocrinopathies that are controlled by hormone replacement.

High-dose corticosteroids, such as dexamethasone, together with any other agent were similarly significantly associated with an elevated mortality risk relative to positive and negative controls, with ORs of 2.04 and 3.16, respectively, after adjusting for factors such as comorbidities, cancer status, and baseline COVID-19 severity.

Poor outcomes among patients with non-small-cell lung cancer who receive corticosteroids prior to immunotherapy are driven by the use of steroids for palliative oncologic symptom management, study findings indicate.

The Committee also reviewed the research and has advised on the management of CRF through exercise, psychosocial interventions, mind–body interventions, yoga, acupuncture, and the use of pharmacologic agents including psychostimulants, antidepressants, acetylcholinesterase inhibitors, and corticosteroids, as well as nutraceutical treatments. medwireNews is an independent medical news service provided by Springer Healthcare. © 2020 Springer Healthcare part of the Springer Nature group Ann Oncol 2020; https://doi.org/10.1016/j.annonc.2020.02.016

Gupta et al say that three patients were treated “successfully” with nonsteroidal anti-inflammatory drugs or acetaminophen, supplemented with intra-articular corticosteroids in one case, while treatment with oral prednisone (alongside methotrexate in one case) led to the resolution of musculoskeletal symptoms in the remaining five patients.

Combining abiraterone acetate with a relatively high dose of prednisone or dexamethasone may reduce mineralocorticoid excess toxic effects, but can result in increased metabolic toxicity, study data show.

Of equal importance according to the investigators was the fact that “[t]he use of systemic corticosteroids did not seem to negatively affect the chances of developing a response and did not seem to affect the duration of response.”

Specifically, patients who discontinued corticosteroids up to 30 days before PD-1 or PD-L1 inhibitor initiation had PFS and OS that was intermediate between those who were taking corticosteroids on the day that immune checkpoint blockade was initiated and those who received no corticosteroids within 30 days of the start of therapy.

Early stage CTCL For early-stage disease, SDTs are first-line options, and the mainstays of treatment include corticosteroids, ultraviolet light therapy, topical bexarotene gel (Targretin® gel), and topical mechlorethamine gel (nitrogen mustard gel; Valchlor®) (Table 1).

This chapter provides an overview of the early development and clinical studies of the serotonin (5-hydroxytryptamine-3) receptor antagonists in the prevention of chemotherapy-induced nausea and vomiting. Summary Different chemotherapeutic treatments have different intrinsic emetogenicity, the key determinant of the probability of clinical emesis, described as high, moderate, low and minimum. The 5-HT3 receptor was identified as a potential mediator of the antiemetic effect, and various strategies were employed to develop selective 5-HT3 receptor antagonists, including: Screening indole analogues, leading to the development of ondansetron Structure-activity relationships around cocaine resulting in development of dolasetron Using serotonin as a basis, leading to the development of tropisetron Structure-activity relationships around tropisetron leading to granisetron. The first generation 5-HT3 receptor antagonists (ondansetron, dolasetron, tropisetron, and granisetron) all have the following properties: Contain an indole ring Elimination half-life of ~4–8 hours Oral formulations well absorbed with approximate 60% bioavailability The lowest effective dose has been determined. Antiemetic efficacy superior to placebo and older antiemetics (except high-dose metoclopramide) No significant differences in antiemetic efficacy between the four drugs Antiemetic efficacy superior when combined with corticosteroids. Adverse effects largely confined to constipation and headache, although QTc prolongation has become a regulatory concern. The second generation 5-HT3 receptor antagonist, palonosetron, was identified as a compound with significantly increased affinity for the receptor, a prolonged half life (~42 hours) and no meaningful effect on QTc interval. While initial formulations were intravenous, the development of oral forms provided more convenient dosing. Moreover, there are several novel delivery methods for 5-HT3 receptor antagonists available, most notable of which are transdermal granisetron and sustained-release subcutaneous granisetron. The first-generation 5-HT3 receptor antagonists significantly improved emesis associated with cytotoxic chemotherapy, but nausea remains a persistent problem. Chen R, Deng K, Raftopoulos H. In: Management of Chemotherapy-Induced Nausea and Vomiting . Edited by: Navari R. Springer International Publishing Switzerland 2016. doi: 10.1007/978-3-319-27016-6_3

Nine percent of participants in the avelumab–axitinib group experienced immune-related AEs of grade 3 or 4, and 11% needed high-dose corticosteroids for the management of immune-related AEs, Motzer reported.

A phase II proof-of-concept study has shown that clinically stable patients with metastatic castration-resistant prostate cancer and limited disease progression during treatment with abiraterone acetate plus prednisone can experience biochemical and radiologic responses following a steroid switch to dexamethasone.