Описание
Prednisone at immunosuppressive doses may blunt pembrolizumab's anti-tumour efficacy by dampening the T-cell responses required for checkpoint inhibitor activity.
Механизм
Corticosteroids suppress T-cell proliferation, cytokine secretion, and effector function through glucocorticoid receptor-mediated gene regulation; this directly antagonises the mechanism by which pembrolizumab augments anti-tumour immunity.
Клиническое значение
Retrospective studies and meta-analyses indicate decreased pembrolizumab efficacy (lower ORR, shorter PFS) in patients who require corticosteroid doses equivalent to >10 mg prednisone/day at the time of anti-PD-1 initiation.
Тактика ведения
Avoid prophylactic or elective corticosteroid use with pembrolizumab; when steroids are required for irAEs or other indications, use the lowest effective dose and taper as rapidly as clinically safe.
Медицинский отказ от ответственности
This content is for educational and informational purposes only. It is not a substitute for professional medical advice, diagnosis, or treatment. Always consult a qualified healthcare provider before making medication decisions.