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ICI Hepatitis Rechallenge Criteria — SCE Medical Oncology MCQ

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ModerateLung CancerICI Hepatitis Rechallenge CriteriaSCE Medical Oncology

A 55-year-old woman with NSCLC on immunotherapy develops grade 2 immune-related hepatitis (ALT 5× ULN). After holding pembrolizumab and starting prednisolone 1 mg/kg, ALT normalises within 2 weeks. When can pembrolizumab be restarted?

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Correct answer: A — Pembrolizumab can be cautiously restarted when ALT returns to ≤grade 1 (≤3× ULN) AND prednisolone has been tapered to ≤10 mg/day — close LFT monitoring (weekly for 4 weeks) is essential after rechallenge

For grade 2 immune-related hepatitis, withhold checkpoint inhibition and treat according to the severity pathway. Rechallenge is considered only after liver tests return to grade 1 or baseline and corticosteroids have tapered to a low dose, typically no more than prednisolone 10 mg/day, after individual multidisciplinary assessment. Monitor closely because hepatitis can recur.

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