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irAEs — SCE Medical Oncology MCQ

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EasyImmunotherapy & Targeted TherapyirAEsSCE Medical Oncology

A 55-year-old woman on ipilimumab + nivolumab for melanoma develops grade 2 immune-related diarrhoea (4-6 stools above baseline per day). Stool cultures and C. difficile are negative. What is the initial management for grade 2 ICI-related diarrhoea?

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Correct answer: B — Hold immunotherapy and start oral budesonide or prednisolone 0.5-1 mg/kg/day

For grade 2 immune-related diarrhoea/colitis, ICIs should be held and oral corticosteroids (budesonide 9 mg/day for mild grade 2 or prednisolone 0.5-1 mg/kg for persistent grade 2) should be started. Grade 2 that does not improve within 5-7 days should be managed as grade 3 (escalate to prednisolone 1-2 mg/kg). Loperamide can provide symptomatic relief but should not delay corticosteroid initiation when colitis is suspected. Colonoscopy may be considered for persistent or atypical cases.

Reference: ESMO 2024 irAE Management Guidelines; ASCO irAE Guidelines 2021