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irAEs — SCE Medical Oncology MCQ

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HardImmunotherapy & Targeted TherapyirAEsSCE Medical Oncology

Ten days after atezolizumab, a patient develops ptosis, fatigable diplopia, neck-flexor weakness and dysphagia. Creatine kinase and troponin are raised, but brain imaging shows no metastasis. What is the most appropriate atezolizumab-specific action while urgent neuromuscular and cardiac assessment begins?

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Correct answer: D — Permanently discontinue atezolizumab because suspected immune myasthenia is a permanent-stop toxicity at any grade

The phenotype suggests checkpoint-inhibitor myasthenia with myositis and possible myocarditis overlap. The Tecentriq SmPC requires permanent discontinuation for myasthenic syndrome or myasthenia gravis at all grades; dose reduction is not recommended. Raised troponin makes parallel myocarditis investigation and monitoring urgent. Waiting for electrophysiological proof, using CK alone to decide rechallenge, or continuing treatment risks rapid bulbar, respiratory or cardiac deterioration.

Reference: Tecentriq 1,200 mg UK summary of product characteristics (Current UK SmPC, accessed August 2026): https://www.medicines.org.uk/emc/product/8442/smpc