How slow should we go? Variation and outcomes of steroid tapering for immunotherapy-related toxicities in gynecologic cancer.

Authors

Jessica Velasquez, Julia Chalif, Danielle Glassman, Anna Gonzalez, Reed O'Connor, Cassidy Abdeen, Floor J Backes, David E Cohn, Larry J Copeland, Casey M Cosgrove, Paulina J Haight, Christa I Nagel, Robert Neff, David M O'Malley, Laura M Chambers

Published in

Gynecologic oncology. Volume 214. Pages 128-133. Oct 20, 2026. Epub Oct 20, 2026.

Abstract

This study examined both National Comprehensive Cancer Network (NCCN) guideline concordance and steroid taper duration with clinical outcomes in patients with gynecologic malignancies experiencing immune-related AEs.
This single-institution retrospective cohort included patients with gynecologic malignancies treated with immune checkpoint inhibitor (ICI) from August 2016 to September 2025 who developed grade 3 or 4 immune-related AEs requiring systemic steroids. Clinical and steroid treatment data were abstracted. NCCN guideline concordance and outcomes were assessed.
63 patients contributing 73 steroid tapers were included. Most patients had endometrial (41.3%), cervical (27.0%), or ovarian cancer (23.8%), and pembrolizumab was the most used ICI (74.6%). 46 tapers (63.0%) were NCCN guideline concordant and 27 (37.0%) were NCCN guideline discordant, with discordance most often driven by taper length and premature initiation. 14 (19.2%) were < 28 days, and 59 (80.8%) were ≥ 28 days. NCCN discordant tapers were more likely to require additional supportive medications for irAE management (e.g. secondary steroids) than concordant tapers (81.5% vs 56.2%, p = 0.0300). NCCN concordance was associated with longer time to ICI restart (56 vs 21 days, p = 0.0241). Tapers <28 days were more likely to require additional supportive medications (100% vs 57.6%, p = 0.0027) and steroids (35.7% vs 8.4%, p = 0.0253) than tapers ≥28 days. Tapers ≥28 days were associated with higher rates of ICI discontinuation due to toxicity (59.3% vs 28.6%, p = 0.0381). Rates of hospitalization, ICU admission, and AE resolution did not differ by NCCN concordance or taper duration.
Corticosteroid taper practices varied substantially in patients with gynecologic malignancies experiencing severe irAEs; shorter and guideline-discordant tapers were associated with greater treatment escalation and steroid reinitiation.

PMID:
42900968
Bibliographic data and abstract were imported from PubMed on 21 Oct 2026.

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