Skill Checkup: A 48-Year-Old Triple-Negative Breast Cancer Patient Falls Ill During Immune Checkpoint Inhibitor Therapy

Kelly E. McCann, MD, PhD

Disclosures

May 24, 2022

The main approach to treating IRAEs is systemic corticosteroid use. Additional treatment may also involve supportive care and immunomodulatory strategies. Considering that the patient in the present case is experiencing grade 2 pneumonitis, ICI should be held, and high-dose corticosteroids should be initiated, starting with methylprednisolone 1mg/kg/day with escalation in dosage, additional immunosuppression, and/or reconsideration of the diagnosis if no improvement in 2-3 days. If symptoms improve to ≤ grade 2 by day 2-3 of corticosteroids or supportive care, a slow steroid taper can be started over > 1 month.

If symptoms do not improve or worsen, pneumonitis should then be treated as grade 3-4. Management should be coordinated among disease specialists. Other immunomodulatory agents may be required, such as infliximab, other tumor necrosis factor inhibitors, mycophenolate mofetil, antithymocyte globulin, calcineurin inhibitors, methotrexate, or IVIG and plasmapheresis.

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