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Table 2 General guidance for corticosteroid management of immune-related adverse events

From: Managing toxicities associated with immune checkpoint inhibitors: consensus recommendations from the Society for Immunotherapy of Cancer (SITC) Toxicity Management Working Group

Grade of immune-related AE (CTCAE/equivalent) Corticosteroid management Additional notes
1 • Corticosteroids not usually indicated • Continue immunotherapy
2 • If indicated, start oral prednisone 0.5-1 mg/kg/day if patient can take oral medication.
• If IV required, start methylprednisolone 0.5-1 mg/kg/day IV
• If no improvement in 2–3 days, increase corticosteroid dose to 2 mg/kg/day
• Once improved to ≤grade 1 AE, start 4–6 week steroid taper
• Hold immunotherapy during corticosteroid use
• Continue immunotherapy once resolved to ≤grade 1 and off corticosteroids
• Start proton pump inhibitor for GI prophylaxis
3 • Start prednisone 1-2 mg/kg/day (or equivalent dose of methylprednisolone)
• If no improvement in 2–3 days, add additional/alternative immune suppressant
• Once improved to ≤ grade 1, start 4–6-week steroid taper
• Provide supportive treatment as needed
• Hold immunotherapy; if symptoms do not improve in 4–6 weeks, discontinue immunotherapy
• Consider intravenous corticosteroids
• Start proton pump inhibitor for GI prophylaxis
• Add PCP prophylaxis if more than 3 weeks of immunosuppression expected (>30 mg prednisone or equivalent/day)
4 • Start prednisone 1-2 mg/kg/day (or equivalent dose of methylprednisolone)
• If no improvement in 2–3 days, add additional/alternative immune suppressant, e.g., infliximab
• Provide supportive care as needed
• Discontinue immunotherapy
• Continue intravenous corticosteroids
• Start proton pump inhibitor for GI prophylaxis
• Add PCP prophylaxis if more than 3 weeks of immunosuppression expected (>30 mg prednisone or equivalent/day)
  1. Note: For steroid-refractory cases and/or when steroid sparing is desirable, management should be coordinated with disease specialists. AE, adverse event