Study Finds Steroid Use Associated with Worse Survival Rates for Patients Receiving Cancer Immunotherapy

Findings from Mass General Brigham researchers highlight importance of carefully considering steroid dose, duration, and timing in patients taking immune checkpoint inhibitors.

Researchers at Mass General Brigham have found that patients with cancer treated with immune checkpoint inhibitors (ICIs), who were also given systemic glucocorticoids (synthetic versions of steroid hormones), had worse survival outcomes than those who did not receive steroids. Outcomes were poorer when steroids were given close to the start of immunotherapy, at higher doses, or for longer periods. Results are published in JAMA Network Open.

“The message is not that steroids should never be used—many patients need them, and they can be lifesaving,” said Eugene Semenov, MD, MA, FAAD, co-director of the Oncodermatology Program in the Mass General Brigham Department of Dermatology and the lead author of the study. “Instead, their use during immunotherapy should be treated as a major clinical decision. Our study helps with that decision by identifying specific timing, dose, and duration patterns most strongly associated with poorer survival outcomes.”

ICIs work by helping the immune system recognize and attack tumor cells. Steroids broadly suppress immune activity, which may blunt the effect of ICIs. Previous studies have found an association between steroids and shortened survival among patients on ICIs; however, the research was limited to specific doses, short follow-up periods, and specific types of cancer.

For the new study, researchers analyzed health record data from 39,258 patients, including 13,086 patients treated with ICIs at Massachusetts General Hospital, Brigham and Women’s Hospital, and Dana-Farber Cancer Institute, and 26,172 U.S. patients from the TriNetX database.

The 27.8% of patients who received systemic steroids had significantly worse survival than patients who did not receive steroids. The strongest association was seen when steroids were administered within one month before or after starting immunotherapy. In that group, survival was approximately 51% shorter, compared with patients who did not receive steroids during that period.

The authors analyzed 1,128 patient records manually to verify medication doses and durations and found survival outcomes worsened as steroid doses and durations increased. The findings remained consistent across multiple patient populations and cancer types.

A limitation of the study is that its retrospective design means it’s possible patients who received steroids had other complications such as more advanced cancer or severe treatment-related side effects that independently increased their risk of death. However, in the manually reviewed cohort, 92.3% of deaths among patients who received steroids were due to cancer, not treatment-related side effects. In addition, when researchers adjusted for cancer stage and comorbidities, the association between steroid use and shortened survival remained strong.

Authorship: In addition to Semenov, Mass General Brigham authors include Guihong Wan, Nga Nguyen, Charles Lu, Sara Khattab, Boshen Yan, Munachimso Amadife, Bonnie W. Leung, Wenxin Chen, Ahmad Rajeh, Kimberly Tang, Christopher Thang, Genevieve Boland, Kerry L. Reynolds, Kun-Hsing Yu, and Nicole R. LeBoeuf. Additional authors include Alexander Gusev and Shawn G. Kwatra.

Disclosures: Semenov reported receiving personal fees from Sanofi, Regeneron, Arcutis, Alterome Inc, BMS, Pfizer Inc, Galderma, and Pyxis Inc outside the submitted work. Additional author disclosures can be found in the paper.

Funding: This study was supported in part by the National Cancer Institute (K99CA286966 and R00CA286966) National Institutes of Health (R35GM142879 and R01HL174679), the U.S. Department of Defense (HT9425-23-1-0523, W81XWH2110819), the National Institute of Arthritis and Musculoskeletal Skin Diseases (K23AR080791 and R01AR085629), and the Melanoma Research Alliance. The funders had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication.

Paper cited: Wan G, et al. “Systemic Glucocorticoid Immunosuppression and Survival Among Immune Checkpoint Inhibitor Recipients.” JAMA Network Open DOI: 10.1001/jamanetworkopen.2026.14323