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SJS/TEN — SCE Medical Oncology MCQ

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HardOncological EmergenciesSJS/TENSCE Medical Oncology

A 65-year-old woman with advanced NSCLC develops severe Stevens-Johnson syndrome (SJS) while on pembrolizumab + chemotherapy. She has mucosal involvement (oral, ocular, genital) and epidermal detachment of 12% BSA. What is the immediate management?

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Correct answer: B — Permanently discontinue pembrolizumab, admit to burns unit/HDU, start IV corticosteroids, ophthalmology/dermatology urgent review

SJS/TEN is a life-threatening dermatological irAE (mortality 10-30%) requiring immediate ICI permanent discontinuation, burns unit/HDU admission, IV corticosteroids (methylprednisolone 1-2 mg/kg), and multidisciplinary urgent review (dermatology, ophthalmology, gynaecology for mucosal involvement). IVIG or ciclosporin may be considered for severe cases. Supportive care includes wound management, fluid replacement, nutritional support and infection prevention. This is an absolute contraindication to any future ICI rechallenge.

Reference: ESMO 2024 irAE Management Guidelines; ASCO irAE Guidelines; Roujeau et al NEJM 1995