ICI Colitis — RACP Adult Medicine MCQ

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ModerateMedical OncologyICI ColitisRACP Adult Medicine

A 60-year-old man with a history of melanoma treated with combination immunotherapy (nivolumab + ipilimumab) develops severe diarrhoea (>7 episodes/day) with bloody stools. Colonoscopy shows diffuse colonic ulceration. What is the most appropriate treatment?

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Correct answer: C — IV methylprednisolone 2 mg/kg/day

Grade 3–4 immune checkpoint inhibitor-induced colitis (severe diarrhoea, bloody stools, diffuse ulceration) requires high-dose IV corticosteroids (methylprednisolone 1–2 mg/kg/day). Immunotherapy must be permanently discontinued. If no response to steroids within 48–72 hours, infliximab 5 mg/kg should be commenced. The combination of nivolumab + ipilimumab has the highest rate of immune-related colitis (~15–20%). GI perforation must be excluded before infliximab.

Reference: ASCO – 2021 – irAE Management Guidelines; eTG – 2025 – Gastrointestinal