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NSCLC — SCE Medical Oncology MCQ

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HardLung CancerNSCLCSCE Medical Oncology

After two pembrolizumab cycles, a patient develops hypoxaemic pneumonitis requiring supplemental oxygen. CT shows bilateral ground-glass change, and infection and pulmonary embolism are being evaluated. If this is grade 3 immune-mediated pneumonitis, which treatment action follows the UK product information?

Educational content. Not a substitute for clinical judgement or local policy.

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Correct answer: D — Permanently discontinue pembrolizumab and give systemic corticosteroid at 1–2 mg/kg/day prednisone equivalent

Explanation lettering: B = shown as A · E = shown as B · A = shown as C · C = shown as E

D is correct. The Keytruda SmPC requires permanent discontinuation for grade 3 or 4 pneumonitis and corticosteroid treatment at an initial prednisone-equivalent dose of 1–2 mg/kg/day, followed by a taper. Infection, embolism, progression and cardiac causes are assessed in parallel, but a severely hypoxaemic patient is treated while that work proceeds. Continuing, dose-reducing or restarting pembrolizumab during grade 3 toxicity conflicts with the product algorithm; checkpoint inhibitors are not managed by percentage dose reduction. Switching directly to nivolumab preserves the same immune-toxicity mechanism and is not acute management.

Reference: Keytruda UK Summary of Product Characteristics: https://www.medicines.org.uk/emc/product/101749/smpc