My Treatment Approach: Evolving Treatment Strategies in Metastatic Melanoma - Episode 14
Corticosteroid Treatment Challenges in Patients with Immunotherapy-Related Toxicities
A panel of oncology experts explore the challenges in treating patients with immunotherapy-related toxicities using corticosteroids.
This is a video synopsis/summary of an OncLive Insights involving Afreen Shariff, MD, MBBS; Javid Moslehi, MD; and Nikhil Khushalani, MD.
Dr Shariff asks about managing steroid-refractory immune-related adverse events. Dr Khushalani states that for most grade 3 to 4 immune-related adverse events requiring intravenous steroids, his threshold to add another agent like infliximab or mycophenolate is low if there is no response in 48 to 72 hours. While most toxicity resolves with a steroid taper over 4 to 6 weeks, some patients relapse when tapering and require additional immunosuppression.
Regarding optimal steroid dosing, Dr Moslehi notes recent data in nearly 1000 myocarditis patients showed no outcomes difference between high-dose (>2 mg/kg per day) and low-dose (<1 mg/kg per day) regimens. The panel agrees balancing efficacy against long-term toxicity risk with prolonged high-dose steroids is challenging. Dr Shariff concludes it can be difficult to distinguish adrenal insufficiency symptoms from immune-related adverse events when tapering patients off steroids.
Video synopsis is AI-generated and reviewed by OncLive® editorial staff.
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