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irAEs — SCE Medical Oncology MCQ

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HardImmunotherapy & Targeted TherapyirAEsSCE Medical Oncology

A 60-year-old man receiving ipilimumab + nivolumab for melanoma develops grade 3 immune-related hepatitis (ALT 12× ULN). After 5 days of IV methylprednisolone 2 mg/kg, his ALT has not improved. What is the recommended second-line immunosuppressant for steroid-refractory immune-related hepatitis?

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Correct answer: B — Mycophenolate mofetil

For steroid-refractory immune-related hepatitis, mycophenolate mofetil (MMF) is the recommended second-line agent. Infliximab is contraindicated in ICI-related hepatitis due to its own hepatotoxicity risk. This differs from ICI-related colitis where infliximab is first-line after steroids. Tacrolimus and azathioprine are alternative options if MMF is ineffective or not tolerated.

Reference: https://www.nice.org.uk/guidance/conditions-and-diseases/cancer