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Melanoma — SCE Dermatology MCQ

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HardSkin CancerMelanomaSCE Dermatology

A 60-year-old man with advanced melanoma is started on combined Ipilimumab (anti-CTLA-4) and Nivolumab (anti-PD-1). After 3 cycles he develops grade 3 colitis with bloody diarrhoea. What is the recommended management?

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Correct answer: D — Hold immunotherapy and start IV Methylprednisolone 2 mg/kg/day

Grade 3-4 immune-related adverse events (irAEs) from checkpoint inhibitors require immediate withholding of immunotherapy and high-dose systemic corticosteroids (IV Methylprednisolone 2 mg/kg/day for colitis). If no improvement within 48-72 hours, Infliximab should be considered (unless hepatitis is the irAE). For grade 3 colitis, immunotherapy should generally be permanently discontinued. irAEs can affect any organ — colitis, hepatitis, pneumonitis, endocrinopathies (thyroiditis, hypophysitis), and dermatological toxicity (rash, vitiligo, lichenoid eruptions, bullous pemphigoid) are common. Dermatological irAEs may paradoxically predict better tumour response.

Reference: NICE NG14 Melanoma; ESMO irAE Guidelines 2022