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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
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