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Immune-related Adverse Events from Immune Checkpoint Inhibitor Therapy

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49 Table 7. Nervous System Toxicities G2: Moderate: some interference with ADLs, symptoms concerning to patient. • Discontinue ICPi. • Admission to inpatient unit with capability of rapid transfer to ICU-level monitoring. • Start IVIG (0.4 G/kg/day for 5 days for a total dose of 2 G/kg ) or plasmapheresis. Note: plasmapheresis immediately after IVIG will remove immunoglobulin. • Corticosteroids are usually not recommended for idiopathic GBS, however in ICPi-related forms, a trial is reasonable (methylprednisolone 2–4 mg/kg/day), followed by slow steroid taper. Pulse steroid dosing (methylprednisolone 1 gram daily for 5 days) may also be considered for G3–4 along with IVIG or plasmapheresis. After pulse steroids, taper steroids over 4–6 weeks. • Frequent neuro checks and pulmonary function monitoring. • Monitor for concurrent autonomic dysfunction. • Non-opioid management of neuropathic pain, for example, pregabalin, gabapentin, or duloxetine. • Treatment of constipation/ileus. G3–4: Severe: limiting self-care and aids warranted, weakness limiting walking, ANY dysphagia, facial weakness, respiratory muscle weakness, or rapidly progressive symptoms. Additional considerations: • Extreme caution with rechallenging for severe cases after complete resolution of symptoms and tapered off immunosuppression. (cont'd)

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