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irAE Management — SCE Medical Oncology MCQ

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EasyLung CancerirAE ManagementSCE Medical Oncology

A 70-year-old man with stage IV squamous NSCLC on pembrolizumab + carboplatin + paclitaxel develops grade 3 immune-related hepatitis. Pembrolizumab is permanently discontinued. After resolution, can he continue carboplatin + paclitaxel chemotherapy without immunotherapy?

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Correct answer: B — Yes — chemotherapy can continue without ICI if the patient is still benefiting and fit enough

When ICI is permanently discontinued due to a severe irAE, the chemotherapy component can be continued if the patient is still deriving benefit and is fit for treatment. Chemotherapy and immunotherapy act through different mechanisms, and there is no pharmacological contraindication to continuing chemotherapy after ICI cessation for toxicity. The irAE should be fully resolved (or managed with ≤10 mg prednisolone) before resuming chemotherapy.

Reference: ESMO 2024 irAE Management Guidelines; Clinical practice