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irAEs — SCE Medical Oncology MCQ

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HardImmunotherapy & Targeted TherapyirAEsSCE Medical Oncology

A 68-year-old on pembrolizumab develops a pruritic, non-bullous maculopapular eruption affecting about 20% of body surface area. He is systemically well and daily activities are unaffected. What grade and initial management are most appropriate?

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Correct answer: D — Grade 2 rash; continue cautiously with potent topical corticosteroid treatment

A non-bullous eruption covering about 20% BSA with preserved activities is grade two and can be managed initially with potent topical corticosteroid while treatment continues cautiously. Grade 1 rash; continue checkpoint treatment with potent topical corticosteroid: twenty-percent body-surface involvement falls within grade two rather than grade one. Grade 2 rash; hold checkpoint treatment and start oral prednisolone immediately: a well patient with unaffected daily activities can generally begin with topical therapy. Grade 3 rash; hold checkpoint treatment and start oral prednisolone: grade three requires greater surface area or functional impact. Grade 4 rash; discontinue checkpoint treatment and arrange critical-care review: there is no life-threatening epidermal detachment or systemic compromise.

Reference: KEYTRUDA 25 mg/mL UK summary of product characteristics (Current UK SmPC, updated June 2026): https://www.medicines.org.uk/emc/product/2498/smpc