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irAEs — SCE Medical Oncology MCQ

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HardImmunotherapy & Targeted TherapyirAEsSCE Medical Oncology

After four pembrolizumab cycles, a patient develops dyspnoea, bilateral ground-glass change and a new oxygen requirement of 2 L/min. Cultures and viral testing are negative. Which management best matches this grade 3 immune-related pneumonitis?

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Correct answer: B — Admit, permanently stop pembrolizumab and start intravenous methylprednisolone 1–2 mg/kg/day

An oxygen requirement makes this severe pneumonitis. The SmPC requires permanent discontinuation for grade 3 or 4 pneumonitis and recommends systemic corticosteroid at a prednisone-equivalent dose of 1–2 mg/kg/day for grade 2 or worse disease. Infection should be excluded promptly, but treatment must not await elective bronchoscopy.

Reference: KEYTRUDA UK summary of product characteristics (Updated June 2026): https://www.medicines.org.uk/emc/product/2498/smpc