irAE Sicca Syndrome — SCE Medical Oncology MCQ

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ModerateImmunotherapy & Targeted TherapyirAE Sicca SyndromeSCE Medical Oncology

A 60-year-old woman on nivolumab for NSCLC develops immune-related sicca syndrome (severe dry eyes and dry mouth). Schirmer test is positive (<5 mm wetting). ANA and anti-SSA/SSB are negative. What is the management?

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Correct answer: A — For grade 1-2 sicca as the investigation

ICI-induced sicca syndrome (dry eyes/mouth from salivary and lacrimal gland inflammation) is managed with a graded approach: Grade 1-2 (mild-moderate dryness): continue ICI + supportive measures (preservative-free artificial tears, artificial saliva sprays/gels, pilocarpine 5 mg TDS for mouth dryness, regular dental assessment). Grade 3 (corneal ulceration, unable to eat/drink): hold ICI, systemic corticosteroids, specialist referral. Autoantibodies (ANA, anti-SSA/B) are usually negative in ICI-induced sicca (unlike primary Sjögren's).

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