对于接受程序性细胞死亡 1 (PD-1) 轴阻断治疗的非小细胞肺癌 (NSCLC) 患者，基线皮质类固醇暴露与较差的临床结果相关。地塞米松是一种强效皮质类固醇，用于预防化疗相关不良事件（CAAE）。由于地塞米松具有免疫抑制特性，本研究试图阐明其对非鳞状 NSCLC 患者免疫治疗加化疗疗效的影响。该研究回顾性地进行分析了 254 名晚期非鳞状 NSCLC 患者的病历，这些患者在三个学术机构接受了 PD-1 通路抑制剂和铂类化疗的一线治疗。计算每个化疗周期预防性地塞米松的平均剂量。根据地塞米松剂量将患者分为三组：高剂量组（≥24 毫克）、中剂量组（12-24 毫克）和低剂量组（<12 毫克）。 Spearman等级相关用于评估地塞米松剂量与无进展生存期（PFS）之间的相关性。使用逻辑回归评估地塞米松剂量与免疫相关不良反应（irAE）发生之间的相关性。采用单变量和多变量Cox比例风险回归模型分析不同地塞米松剂量组间生存率的差异。预防性地塞米松剂量与PFS无显着相关性（Spearman's rho=-0.103，P=0.098）。单变量结果[风险比 (HR)Low-d/High-d, 1.00； P = 0.997； HR 中 d/高 d，0.85； P = 0.438] 和多变量（HRLow-d/High-d，0.71；P = 0.174；HRModerate-d/High-d，0.87；P = 0.512）分析显示地塞米松与 PFS 之间没有显着关联。地塞米松对客观缓解率、疾病控制率或总生存期没有显着影响。所有三组的 irAE 毒性特征相似。这项研究的结果表明，预防性使用地塞米松不会对接受 PD-1 阻断疗法和化疗的非鳞状 NSCLC 患者的临床结果产生不利影响。对于接受联合免疫治疗和化疗的患者，应建议常规使用地塞米松来预防 CAAE。版权所有 © 2023 作者。由 Elsevier B.V. 出版。保留所有权利。

Baseline corticosteroids exposure is associated with inferior clinical outcomes in patients with non-small-cell lung cancer (NSCLC) treated with programmed cell death-1 (PD-1) axis blockade. Dexamethasone is a potent corticosteroid used in the prevention of chemotherapy-associated adverse events (CAAEs).Since dexamethasone has immunosuppressive properties, this study attempted to elucidate its effects on the efficacy of immunotherapy plus chemotherapy in patients with non-squamous NSCLC.The study retrospectively analyzed the medical records of 254 advanced non-squamous NSCLC patients who received front-line treatment with a PD-1 pathway inhibitor and platinum-based chemotherapy at three academic institutions. The average dosage of prophylactic dexamethasone per chemotherapy cycle was calculated. Patients were divided into three groups based on the dose of dexamethasone: High-d (≥24 mg), Moderate-d (12-24 mg), and Low-d (<12 mg). Spearman's rank correlation was used to assess the correlation between the dosage of dexamethasone and progression-free survival (PFS). Logistic regression was used to assess the correlation between dexamethasone dosage and the occurrence of immune related adverse effects (irAE). Univariate and multivariate Cox proportional hazards regression models were used to analyze the differences in survival among the different dexamethasone dosage groups.The dosage of prophylactic dexamethasone was not significantly correlated with PFS (Spearman's rho = -0.103, P = 0.098). Results from the univariate [hazard ratio (HR)Low-d/High-d, 1.00; P = 0.997; HRModerate-d/High-d, 0.85; P = 0.438] and multivariate (HRLow-d/High-d, 0.71; P = 0.174; HRModerate-d/High-d, 0.87; P = 0.512) analyses showed no significant association between dexamethasone and PFS. Dexamethasone did not have significant effect on the objective response rate, disease control rate or overall survival. The toxicity profiles of irAE were similar across all three groups.The results of this study suggest that the use of prophylactic dexamethasone does not have an adverse effect on the clinical outcomes of non-squamous NSCLC patients treated with PD-1 blockade therapy and chemotherapy. Routine use of dexamethasone for preventing CAAEs should be recommended for patients undergoing combined immunotherapy and chemotherapy.Copyright © 2023 The Author(s). Published by Elsevier B.V. All rights reserved.