17
Table 1. Cutaneous Toxicities
G3: Rash covering >30%
BSA with moderate or severe
symptoms; limiting self-care
ADL.
• Hold ICPi therapy and consult with dermatolog y
to determine appropriateness of resuming.
• Treat with topical emollients, oral antihistamines,
and high-potency topical corticosteroids. May also
consider phototherapy to treat severe pruritus.
• Initiate oral prednisone or equivalent (1 mg/kg/
day) tapering over at least 4 weeks.
• Once downgraded to ≤G1 and prednisone (or
equivalent) below 10 mg/day, clinicians may
consider resuming ICPi therapy with close
monitoring and follow up with dermatolog y in
certain cases such as psoriasis.
• In patients with pruritis without rash, may treat
with gabapentin, pregabalin, aprepitant, or
dupilumab.
G4: Severe consequences
requiring hospitalization
or urgent intervention
indicated or life-threatening
consequences.
• Immediate hold ICPi
• May admit patient immediately with direct
oncolog y involvement and with an urgent consult
by dermatolog y.
• Systemic steroids: intravenous (IV)
methylprednisolone (or equivalent) dosed at
1–2 mg/kg with slow tapering when the toxicity
resolves.
• Monitor closely for progression to Severe
Cutaneous Adverse Reaction (SCAR).
• Consider alternative antineoplastic therapy over
resuming ICPis if the skin irAE does not resolve to
≤G1. If ICPis are the patient's only option, consider
restarting once these side effects have resolved to a
G1 level with close dermatolog y follow up.
(cont'd)
