Efficacy of topic steroids in the management of asthma and chronic obstructive pulmonary disease in advanced non-small cell lung cancer patients during treatment with nivolumab

Nivolumab is a new immune check point inhibitor that is generally well tolerated and is proven to improve the survival expectancy of metastatic non-small cell lung cancer (NSCLC) patients. Many NSCLC patients, however, suffer from asthma and chronic obstructive pulmonary disease (COPD). The management of these co-morbidities often need high-dose steroid administration that is incompatible with nivolumab treatment since it may impair its efficacy. Nebulized steroid preparations, leading to weak/absent systemic steroid exposure, are potentially suitable drugs in combination with modern immune checkpoint inhibitors. We prescribed inhaled therapy with corticosteroid and a long-acting beta agonist (LA BA) during nivolumab therapy in 4 consecutive patients with advanced NSCLC suffering from concomitant COPD and asthma. These patients obtained a satisfactorily control of respiratory symptoms as assessed by the MRC breathlessness scale. One patient attained a disease response and three patients disease stabilization. The progression free survival was 10, 6, 4, and 5 months, respectively. Nebulized steroid preparations and LABA are efficacious in the management of asthma and COPD associated respiratory symptoms in advanced NSCLC patients submitted to nivolumab therapy. Topic steroids may not have detrimental effect on the efficacy of immunotherapy.