Do high-dose glucocorticoids affect survival in patients with melanoma?

This study investigated whether high-dose glucocorticoids (chemicals that stop inflammation) used for the treatment of ipilimumab (Yervoy)-induced hypophysitis (inflammation of a gland that controls hormones) had any effect on survival in patients with melanoma. This study found that high-dose glucocorticoids was associated with reduced survival in patients with melanoma.

Ipilimumab is a type of targeted cancer drug that helps the body's immune system to attack cancer cells. Many patients who are treated with ipilimumab experience inflammation of the pituitary gland, known as hypophysitis. Hypophysitis is often treated with glucocorticoids, which reduce inflammation by suppressing the immune system. Suppression of the immune system can affect processes which are important for drugs like Ipilimumab to work effectively. This study was conducted because it is unclear whether higher doses of glucocorticoids have any affect on survival of patients treated with ipilimumab.

This study analysed data already collected from patients with melanoma who developed ipilimumab-induced hypophysitis. The effects of different glucocorticoid doses on overall survival and time to treatment failure was analysed. Patients who had low doses of glucocorticoid (a maximum average daily dose of 7.5 mg) were compared to patients who had high doses of glucocorticoid (a maximum average daily dose above 7.5 mg).

Overall survival was 76% longer in patients treated with low dose glucocorticoid compared with patients treated with high dose glucocorticoid. Time to treatment failure was 72% longer in patients treated with low dose glucocorticoid compared with patients treated with high dose glucocorticoid.

All patients who had hypophysitis had improved overall survival compared with patients who did not have hypophysitis. The average length of survival after treatment was 28.2 months for patients who had hypophysitis compared with 9.5 months for patients who did not have hypophysitis. There was no difference in tumor appearance and hormone level outcomes in patients treated with low dose glucocorticoid compared to high dose. There was no difference in symptom relief between the two patient groups.

The study concluded that patients with melanoma who received high doses of glucocorticoids for hypophysitis had reduced survival compared to patients who received low doses.

This study analysed data previously collected which may affect the results. 

Speak to your doctor about the management of immune related side effects associated with ipilimumab.