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irAEs — SCE Medical Oncology MCQ

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HardImmunotherapy & Targeted TherapyirAEsSCE Medical Oncology

A patient develops grade 3 immune-checkpoint-inhibitor hepatitis. Methylprednisolone has produced no biochemical improvement after specialist-confirmed adequate dosing, viral causes are excluded, and bilirubin is rising. Which additional immunosuppressant is generally preferred?

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Correct answer: A — Mycophenolate mofetil

Steroid-refractory immune-mediated hepatitis is generally escalated with mycophenolate under specialist care. Infliximab is avoided because of hepatotoxicity concerns; vedolizumab is gut-selective, tocilizumab is not routine for hepatitis, and cyclophosphamide is not the usual first additional agent.

Reference: NHS Scotland immune-related adverse-event guideline. https://rightdecisions.scot.nhs.uk/media/b11eeh40/woscan-immunotherapy-iraes-guideline-v40.pdf