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ICI Monitoring Protocol — RACP Adult Medicine MCQ

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ModerateMedical OncologyICI Monitoring ProtocolRACP Adult Medicine

A 65-year-old man with metastatic renal cell carcinoma (clear cell type) on combination immunotherapy (nivolumab + ipilimumab) achieves a partial response. What is the most important routine monitoring for immune-related adverse events?

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Correct answer: B — ECG monitoring only

Immune checkpoint inhibitor therapy requires systematic monitoring for irAEs before each treatment cycle. Key tests include: TFTs (thyroiditis – most common endocrine irAE), LFTs (hepatitis), creatinine (nephritis), glucose (new-onset diabetes – rare but can present as DKA), morning cortisol (hypophysitis/adrenalitis), and clinical assessment (skin, GI symptoms, neurological symptoms). The combination of nivolumab + ipilimumab has higher irAE rates (~55–60% grade 3–4) than monotherapy. Early detection enables prompt management and reduces the risk of severe/fatal irAEs.

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