Drug Interactions between budesonide / formoterol and lifileucel

GENERALLY AVOID: The use of systemic corticosteroids may reduce the efficacy of lifileucel, a tumor-derived autologous T-cell immunotherapy agent, as corticosteroids can induce T lymphocyte apoptosis. The exact mechanism by which glucocorticoids exert this effect is not clearly described. Additionally, lifileucel is followed by aldesluekin (interleukin-2 or IL-2) whose efficacy may also be affected by glucocorticoids. The clinical trial which evaluated the efficacy of a single treatment of lifileucel in patients with unresectable or metastatic melanoma who had been previously treated with at least one systemic therapy excluded the enrollment of patients who were on systemic steroids for any reason. Therefore, clinical data examining the use of systemic corticosteroids prior to or during an infusion of lifileucel are not available.

MANAGEMENT: The manufacturer of lifileucel recommends avoiding the prophylactic use of systemic corticosteroids as they may interfere with its activity. Lifileucel is followed by aldesleukin (IL-2) administration, so its potential interactions with corticosteroids should be considered as well. Consultation with institutional protocols, national guidelines, and package labeling may be helpful.

Although they are often combined in clinical practice, the concomitant use of beta-2 adrenergic agonists and corticosteroids may result in additive hypokalemic effects. Since beta-2 agonists can sometimes cause QT interval prolongation, the development of hypokalemia may potentiate the risk of ventricular arrhythmias including torsade de pointes. However, clinical data are limited, and the potential significance is unknown. Patients who are receiving systemic or nebulized formulations of beta-2 agonists, high dosages of inhaled beta-2 agonists, or systemic corticosteroid therapy may be at a greater risk of developing hypokalemia.