# Treat immunotherapy side-effects without wiping out the response

Source: https://onco.cc/ideas/idea-bio2-steroid-sparing-irae/  
OnCo record `idea-bio2-steroid-sparing-irae` (Idea). Data CC BY-NC 4.0, attribute "Data from OnCo (onco.cc)"; commercial use needs a licence.

## TL;DR

Immune side-effects are usually treated with high-dose steroids, which may also switch off the anti-cancer response. Targeted alternatives may control the side-effect and keep the benefit.

## Summary

High cumulative corticosteroid exposure for immune-related adverse events is associated with worse cancer outcomes in several cohorts, although confounding by severity is hard to exclude. Targeted alternatives (early infliximab or vedolizumab for colitis, tocilizumab for arthritis and some pneumonitis, topical or organ-directed therapy) could resolve toxicity with less systemic immunosuppression. A randomised comparison has never been done with cancer outcome as an endpoint.

## Fields

- Kind: Idea
- Last checked: 2026-09-08
- Hypothesis: Targeted first-line immunosuppression for immune-related colitis achieves faster resolution and lower cumulative steroid dose than steroids, without reducing anti-tumour efficacy.
- Rationale: Targeted agents already work as steroid rescue in refractory immune colitis, so efficacy on the toxicity is established; what is untested is whether using them first preserves the anti-tumour response. The trial also improves quality of life regardless of the survival result.
- Proposed test: A randomised trial in grade 2-3 immune-related colitis comparing steroid-first with targeted-first management, with time to resolution, cumulative steroid dose and subsequent progression-free survival as endpoints.
- Maturity: early-clinical
- Actor: clinic

## Sources

- Bottleneck evidence (No one can predict who responds to immunotherapy): Haslam & Prasad (JAMA Network Open 2019): https://doi.org/10.1001/jamanetworkopen.2019.2535

## Connected records

- cancers: [Melanoma](https://onco.cc/cancers/melanoma/), [Non-small-cell lung cancer](https://onco.cc/cancers/nsclc/), [Renal cell carcinoma](https://onco.cc/cancers/rcc/)
- technologies: [Immune checkpoint inhibitors](https://onco.cc/technologies/checkpoint-inhibitor/), [Monoclonal antibodies](https://onco.cc/technologies/monoclonal-antibody/)
- terms: [Immune-related adverse events (irAEs)](https://onco.cc/terms/irae/)
- people: [Aurélien Marabelle](https://onco.cc/people/aurelien-marabelle/)
- bottlenecks: [No one can predict who responds to immunotherapy](https://onco.cc/bottlenecks/b-immunotherapy-response/), [Toxicity and quality of life are undervalued](https://onco.cc/bottlenecks/b-toxicity-qol/)
- key papers: [Estimation of the Percentage of US Patients With Cancer Who Are Eligible for and Respond to Checkpoint Inhibitor Immunotherapy Drugs](https://onco.cc/key-papers/paper-haslam-jama-netw-open/)

---
JSON: https://onco.cc/api/v1/entities/idea-bio2-steroid-sparing-irae.json