Can patients on steroids receive immunotherapy?

Assuming it is clinically indicated, would a checkpoint inhibitor be efficacious in a patient who has a concurrent autoimmune illness (PMR/TA) and is on prednisone? Is low dose prednisone acceptable or would immunotherapy be contraindicated in this case? If so, what is the dose cut-off?

1 Answer

Mednet MemberInvited Expert

Medical Oncology · Wexner Medical Center at The Ohio State University

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In general, it is acceptable to be on the equivalent of 10 mg/day of prednisone (at least this is what has been the cutoff used in most of the trials). Also, patients on replacement doses (presumably of hydrocortisone) for adrenal insufficiency are, of course, also proper treatment candidates for checkpoint inhibitors. The assumption is that higher doses of prednisone (or equivalent) will stunt and potential anti cancer immune response. There is not a great deal of data on the use of checkpoint inhibitors in patients with pre-existing autoimmune disorders, however a quick pubmed search shows that there is a recent publication from the Mayo clinic experience of 16 patients with autoimmune disorders - 5 with RA, 5 PMR, 2 Sjogren's, 2 SLE (Arthritis Rheumatol. 2018 Jan 24). They report that 6 of these patients experienced disease flare and that these flares were successfully treated with glucocorticoids. There is a proposed study through the ALLIANCE looking at the safety of PD1 inhibotors in patients with preexisting autoimmune disorders.