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Steroid Taper irAE — SCE Medical Oncology MCQ

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EasyImmunotherapy & Targeted TherapySteroid Taper irAESCE Medical Oncology

A 55-year-old woman on ICI develops grade 3 immune-related colitis. She is started on IV methylprednisolone. How should corticosteroids be tapered after irAE resolution?

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Correct answer: A — Gradual taper over at least 4-8 weeks — too-rapid steroid taper is the most common cause of irAE relapse; reduce by approximately 10 mg prednisolone equivalent per week

Rapid steroid taper is the most common cause of irAE relapse. After achieving irAE resolution, steroids should be tapered gradually over at least 4-8 weeks (some guidelines suggest ≥6-8 weeks for grade 3 irAEs). A typical taper: reduce prednisolone by 10 mg/week once below 40 mg, then by 5 mg/week below 20 mg. If irAE flares during taper, return to the last effective dose for 1-2 weeks before re-attempting taper. Steroid-sparing immunosuppressants may be needed for steroid-dependent irAEs.

Reference: ESMO 2024 irAE Management; ASCO irAE Guidelines 2021