19
Table 1. Cutaneous Toxicities
G2: Blistering that affects
quality of life and require
intervention based on
diagnosis not meeting criteria
for > Grade 2. Blisters
covering 10%–30% BSA.
• Hold ICPi therapy and consult with dermatolog y
for steroid-sparing options, work up, and to
determine appropriateness of resuming.
• Attention given to general local wound care, which
includes plain petrolatum ointment and bandages
or plain petrolatum ointment gauze and bandage
over any open erosions, which are left over on the
skin after the blister has "popped" or if the roof of
the blister easily sloughs off.
• Initiate class 1 high potency topical steroid,
e.g., clobetasol, betamethasone, or equivalent
and reassess every 3 days for progression or
improvement.
• Low threshold to initiate treatment with
prednisone (or equivalent) at 0.5–1 mg/kg/day
dosing and taper over at least 4 weeks.
• Monitor patients closely for progression to greater
BSA involvement and/or mucous membrane
involvement. Consider following patients closely
using serial photography.
G3: Skin sloughing covering
>30% BSA with associated
pain and limiting self-care
ADL.
• Hold ICPi therapy and consider admitting patient.
• Administer IV methylprednisolone (or equivalent)
1–2 mg/kg and when appropriate convert to oral
steroids, tapering over at least 4 weeks.
• If bullous pemphigoid is diagnosed, it may be possible
to avoid long-term use of systemic steroids and
transition to steroid-sparing options (e.g., intravenous
immunoglobulin (IVIG) and rituximab), as an
alternative approach to treating the irAE.
• Consult with dermatology to determine
appropriateness of resuming ICPi once symptoms
improve.
G4: Blisters covering >30%
BSA with associated fluid or
electrolyte abnormalities.
• Permanently discontinue ICPi.
• Admit patient immediately and place under
supervision of a dermatologist.
• Administer IV methylprednisolone (or equivalent)
1–2 mg/kg and when appropriate convert to oral
steroids, with tapering over at least 4 weeks.
• If bullous pemphigoid is diagnosed, it may be
possible to avoid long-term use of systemic steroids
and treat with steroid-sparing options, as an
alternative approach to treating the irAE (e.g., IVIG
and rituximab).
(cont'd)
