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irAE Vasculitis — SCE Medical Oncology MCQ

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HardImmunotherapy & Targeted TherapyirAE VasculitisSCE Medical Oncology

A 60-year-old man on nivolumab develops immune-related vasculitis presenting with painful red nodules on his legs. Biopsy shows leucocytoclastic vasculitis. CRP is elevated. Organ function is normal. What is the management?

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Correct answer: B — Hold nivolumab, start prednisolone 0.5-1 mg/kg for cutaneous vasculitis; if large-vessel or organ-threatening vasculitis develops, escalate to high-dose steroids ± steroid-sparing immunosuppression

ICI-related vasculitis can affect small vessels (cutaneous leucocytoclastic vasculitis), medium vessels (polyarteritis nodosa-like), or large vessels (giant cell arteritis-like/aortitis). Cutaneous small-vessel vasculitis is managed with ICI hold and prednisolone 0.5-1 mg/kg. Large-vessel or organ-threatening vasculitis requires higher-dose steroids and rheumatology input. PET-CT may show aortic/large-vessel inflammation. ICI rechallenge is generally not recommended for large-vessel vasculitis.

Reference: ESMO 2024 irAE Management; Daxini et al J Immunother Cancer 2018