Impact of antiemetic steroid use on survival in small cell lung cancer patients receiving immune checkpoint inhibitors and chemotherapy
Abstract Immune checkpoint inhibitors (ICIs) combined with conventional cytotoxic agents have become the new standard of care for extensive-stage small cell lung cancer (SCLC). The platinum-based agents in these regimens are highly emetogenic, necessitating prophylactic antiemetic steroids. This stu...
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| Format: | Article |
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Nature Portfolio
2025-07-01
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| Series: | Scientific Reports |
| Online Access: | https://doi.org/10.1038/s41598-025-05899-w |
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| author | Soh Mee Park Jonghyun Jeong Yu Jung Kim Ju-Yeun Lee |
| author_facet | Soh Mee Park Jonghyun Jeong Yu Jung Kim Ju-Yeun Lee |
| author_sort | Soh Mee Park |
| collection | DOAJ |
| description | Abstract Immune checkpoint inhibitors (ICIs) combined with conventional cytotoxic agents have become the new standard of care for extensive-stage small cell lung cancer (SCLC). The platinum-based agents in these regimens are highly emetogenic, necessitating prophylactic antiemetic steroids. This study evaluated the impact of prophylactic antiemetic steroid use on survival outcomes and efficacy in patients with SCLC undergoing combination therapy. Using data from the National Health Insurance Service of Korea database, patients treated with atezolizumab, etoposide, and carboplatin between 2020 and 2022 were categorized by antiemetic steroid dosage. Primary outcomes included overall survival (OS) and time to next treatment (TTNT), assessed using multivariable Cox proportional hazards models. After propensity score matching, 2,116 patients were categorized into low-dose (0–12 mg), moderate-dose (13–24 mg), and high-dose (25–36 mg) groups. Median OS was 10.2 months (interquartile range [IQR] 5.2–18.5), and median TTNT was 8.6 months (IQR 4.8–15.5), with no significant differences among groups. Subgroup analysis revealed increased mortality associated with higher antiemetic steroid doses in patients concurrently receiving non-antiemetic steroids. Although antiemetic steroids did not significantly impact survival outcomes overall, reducing their dosage in patients already on steroid therapy for other indications is recommended. |
| format | Article |
| id | doaj-art-b3e52ee4d45e4edeb073779fe8e029a4 |
| institution | Kabale University |
| issn | 2045-2322 |
| language | English |
| publishDate | 2025-07-01 |
| publisher | Nature Portfolio |
| record_format | Article |
| series | Scientific Reports |
| spelling | doaj-art-b3e52ee4d45e4edeb073779fe8e029a42025-08-20T03:45:28ZengNature PortfolioScientific Reports2045-23222025-07-011511910.1038/s41598-025-05899-wImpact of antiemetic steroid use on survival in small cell lung cancer patients receiving immune checkpoint inhibitors and chemotherapySoh Mee Park0Jonghyun Jeong1Yu Jung Kim2Ju-Yeun Lee3College of Pharmacy and Research Institute of Pharmaceutical Sciences, Seoul National UniversityCollege of Pharmacy and Research Institute of Pharmaceutical Sciences, Seoul National UniversityDivision of Hematology and Medical Oncology, Department of Internal Medicine, Seoul National University College of Medicine, Seoul National University Bundang HospitalCollege of Pharmacy and Research Institute of Pharmaceutical Sciences, Seoul National UniversityAbstract Immune checkpoint inhibitors (ICIs) combined with conventional cytotoxic agents have become the new standard of care for extensive-stage small cell lung cancer (SCLC). The platinum-based agents in these regimens are highly emetogenic, necessitating prophylactic antiemetic steroids. This study evaluated the impact of prophylactic antiemetic steroid use on survival outcomes and efficacy in patients with SCLC undergoing combination therapy. Using data from the National Health Insurance Service of Korea database, patients treated with atezolizumab, etoposide, and carboplatin between 2020 and 2022 were categorized by antiemetic steroid dosage. Primary outcomes included overall survival (OS) and time to next treatment (TTNT), assessed using multivariable Cox proportional hazards models. After propensity score matching, 2,116 patients were categorized into low-dose (0–12 mg), moderate-dose (13–24 mg), and high-dose (25–36 mg) groups. Median OS was 10.2 months (interquartile range [IQR] 5.2–18.5), and median TTNT was 8.6 months (IQR 4.8–15.5), with no significant differences among groups. Subgroup analysis revealed increased mortality associated with higher antiemetic steroid doses in patients concurrently receiving non-antiemetic steroids. Although antiemetic steroids did not significantly impact survival outcomes overall, reducing their dosage in patients already on steroid therapy for other indications is recommended.https://doi.org/10.1038/s41598-025-05899-w |
| spellingShingle | Soh Mee Park Jonghyun Jeong Yu Jung Kim Ju-Yeun Lee Impact of antiemetic steroid use on survival in small cell lung cancer patients receiving immune checkpoint inhibitors and chemotherapy Scientific Reports |
| title | Impact of antiemetic steroid use on survival in small cell lung cancer patients receiving immune checkpoint inhibitors and chemotherapy |
| title_full | Impact of antiemetic steroid use on survival in small cell lung cancer patients receiving immune checkpoint inhibitors and chemotherapy |
| title_fullStr | Impact of antiemetic steroid use on survival in small cell lung cancer patients receiving immune checkpoint inhibitors and chemotherapy |
| title_full_unstemmed | Impact of antiemetic steroid use on survival in small cell lung cancer patients receiving immune checkpoint inhibitors and chemotherapy |
| title_short | Impact of antiemetic steroid use on survival in small cell lung cancer patients receiving immune checkpoint inhibitors and chemotherapy |
| title_sort | impact of antiemetic steroid use on survival in small cell lung cancer patients receiving immune checkpoint inhibitors and chemotherapy |
| url | https://doi.org/10.1038/s41598-025-05899-w |
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