Do corticosteroids slow down the progression of liver cancer?

Corticosteroids Do Not Slow Down the Progression of Liver Cancer

Corticosteroids are not recommended for slowing down the progression of liver cancer as there is no evidence supporting their efficacy for this purpose, and they may potentially worsen outcomes in certain contexts.

Evidence on Corticosteroids in Liver Cancer

Lack of Therapeutic Benefit

• Corticosteroids have not been demonstrated to have anti-tumor effects in hepatocellular carcinoma (HCC) and are not included in any treatment guidelines for liver cancer management 1.
• Current first-line systemic therapies for advanced HCC include tyrosine kinase inhibitors (sorafenib, lenvatinib) and immunotherapy combinations (atezolizumab plus bevacizumab), with no role for corticosteroids as anti-cancer agents 2.

Potential Negative Effects

• In the context of immunotherapy for HCC, corticosteroids administered for cancer-related indications were associated with shorter progression-free survival and higher rates of refractoriness to immune checkpoint inhibitors compared to cancer-unrelated indications 3.
• High-dose corticosteroid combinations (such as nivolumab-ipilimumab) have been associated with high requirements for corticosteroid management of side effects, making them less favorable treatment options when alternatives are available 1.

Specific Contexts Where Corticosteroids Are Used in Liver Disease

• Corticosteroids are indicated in specific liver conditions such as:
  • Autoimmune hepatitis (AIH), where they are a mainstay of treatment 1
  • IgG4-associated cholangitis (IAC), where they can reduce alkaline phosphatase and bilirubin levels 1
  • AIH-PSC (primary sclerosing cholangitis) overlap syndrome, where they may be used in combination with UDCA 1
• However, none of these indications involve using corticosteroids to slow HCC progression 1.

Recent Research on Corticosteroids and Cancer

• A 2023 systematic review found that administration of corticosteroids does not affect response to immunotherapy nor survival outcomes in malignancies when removing confounding palliative corticosteroid indications 4.
• Recent laboratory research suggests that dexamethasone-stimulated glucocorticoid receptor signaling may actually positively regulate mechanisms that could support tumor cell survival in HCC, raising concerns about potential tumor-promoting effects 5.

Clinical Implications

When Corticosteroids May Be Used in Patients with Liver Cancer

• Management of immune-related adverse events from immunotherapy 3
• Symptom control for cancer-related symptoms (pain, nausea, appetite stimulation) 6
• Treatment of comorbid conditions 3
• Procedure-related indications 3

Important Considerations

• Corticosteroids have many potential adverse effects including:
  • Immunosuppression and masked septicemia
  • Myopathy and avascular bone necrosis
  • Oropharyngeal candidiasis
  • Metabolic complications (diabetes, fluid retention) 6
• In patients receiving immunotherapy for HCC, corticosteroid use should be carefully considered and limited to necessary indications 3.

Conclusion

Based on current evidence, corticosteroids should not be used with the expectation of slowing down liver cancer progression. Treatment decisions for HCC should follow established guidelines focusing on approved therapies including surgical approaches, locoregional therapies, and systemic treatments such as tyrosine kinase inhibitors and immunotherapy combinations 1, 2.