skip to main content

ICI Restart After irAE — SCE Medical Oncology MCQ

Instant feedback + full explanation. One question, done properly.

ModerateGI CancersICI Restart After irAESCE Medical Oncology

A 70-year-old man with metastatic gastric cancer is started on first-line nivolumab + FOLFOX. He develops grade 2 immune-related diarrhoea after cycle 3 but it responds to steroids. After resolution, he restarts treatment. Which component should be cautiously restarted?

Educational content. Not a substitute for clinical judgement or local policy.

Reveal the answer and explanation

Correct answer: D — Restart FOLFOX first (at full dose); nivolumab should be restarted cautiously at the scheduled dose only after complete resolution of the irAE to ≤grade 1 — close monitoring for recurrence is essential

After resolution of a grade 2 irAE, the ICI component (nivolumab) can be cautiously restarted at the same dose with close monitoring. The chemotherapy component can typically restart at full dose as it was not the cause of the irAE. For grade 3 irAEs, ICI rechallenge is more nuanced (generally not recommended for grade 3 hepatitis; cautious rechallenge possible for some grade 3 irAEs with close monitoring). The decision should be individualised based on irAE severity, organ involved, alternative treatment options and patient preference.

Reference: https://www.nice.org.uk/guidance/conditions-and-diseases/cancer