irAE Nephritis — SCE Medical Oncology MCQ

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HardImmunotherapy & Targeted TherapyirAE NephritisSCE Medical Oncology

A 58-year-old man on combination ipilimumab + nivolumab develops grade 3 immune-related nephritis. After IV corticosteroids fail to improve creatinine over 7 days, what is the recommended second-line immunosuppressant?

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Correct answer: D — Mycophenolate mofetil

For steroid-refractory immune-related nephritis, mycophenolate mofetil (MMF) is the recommended second-line agent. This differs by organ: colitis → infliximab; hepatitis → mycophenolate (infliximab contraindicated); nephritis → mycophenolate; pneumonitis → infliximab or mycophenolate. Renal biopsy should ideally be performed to confirm the histological pattern (ATIN, glomerulonephritis, etc.) before escalating immunosuppression.

Reference: ESMO 2024 irAE Management Guidelines; Cortazar et al JASN 2020