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Table 1 CTCAE grading of pneumonitis with suggested management as per ESMO guidelines

From: Patterns of immunotherapy-induced pneumonitis in patients with non-small-cell lung cancer: a case series

Grade

Clinical features

Management

1

Asymptomatic

Oral steroids—prednisone 1 mg/kg daily or equivalent with taper over 4–6 weeks after recovery

Clinical and assessment every 2–3 days initially

Delay checkpoint inhibitor until equivalent daily dose of 10 mg oral prednisolone or less

2

Symptomatic—limiting instrumental activities of daily living

As per grade 2

AND

Radiological assessment every 2–3 days initially

3

Severe symptoms—limiting self-care activities of daily living

Hospital admission

High-dose intravenous corticosteroids (methylprednisolone 2–4 mg/kg/day or equivalent)

Cease immunotherapy permanently

Commence immunosuppression if no clinical or imaging improvement after 2 days (such as infliximab, mycophenolate mofetil, cyclophosphamide)

Wean steroids slowly over 6 or more weeks

4

Life-threatening respiratory compromise

As per grade 3

5

Death

 
  1. CTCAE Common Terminology Criteria for Adverse Events, ESMO European Society for Medical Oncology