Table 2.

General Summary of NCCN and SITC Guidelines for irAE Management (Consult guidelines for recommendations for each specific irAE).

Grade (Severity)	Guidelines14,15
1 (mild)	Continue ICI therapy with close monitoringa     • Corticosteroids are not usually required
2 (moderate)	Temporarily discontinue ICI therapy     • Initiate low-dose corticosteroids (0.5-1 mg/kg/d prednisone or equivalent)     • Consult the relevant disease specialists (eg, dermatologists or pulmonary consultants)     • If no improvement in 2 to 3 days, increase corticosteroid dose to 2 mg/kg/d prednisone or equivalent     • Gradually taper corticosteroid dose over at least 4 to 6 weeks once symptoms improve to ≤grade 1     • Provide supportive treatment/care as needed            ˆ Readminister ICI therapy when symptoms improve and/or laboratory values decrease to ≤grade 1 and/or corticosteroid dose has been reduced to <10 mg prednisone or equivalent ˆ For steroid-refractory cases and/or when steroid sparing is desirable, management should be coordinated with disease specialists
3 (severe)	Temporarily discontinue ICI therapy Initiate high-dose corticosteroids (1-2 mg/kg/d prednisone or equivalent) Consult the relevant disease specialists If symptoms do not improve within 2 to 3 days of initiating high-dose corticosteroids, additional/alternative immunosuppressants (eg, mycophenolate mofetil, infliximab) may be offered for some toxicities Gradually taper corticosteroid dose over at least 4 to 6 weeks once symptoms improve to ≤grade 1 Provide supportive treatment/care as needed Consider readministering ICI therapy when symptoms improve to ≤grade 1 and/or corticosteroid dose has been reduced to <10 mg prednisone or equivalent on an individual case basis after benefit–risk discussion with patient Permanently discontinue ICI therapy if symptoms do not improve in 4 to 6 weeks
4 (life-threatening)	Permanently discontinue ICI therapy, except for endocrinopathies controlled with hormone replacement Initiate high-dose corticosteroids (1-2 mg/kg/d prednisone or equivalent) Consider hospitalization Consult the relevant disease specialists If symptoms do not improve within 2 to 3 days, add an additional/alternative immunosuppressant (eg, mycophenolate mofetil, infliximab) Provide supportive treatment/care as needed

Abbreviations: ICI, immune checkpoint inhibitor; irAE, immune-related adverse event; NCCN, National Comprehensive Cancer Network; SITC, Society for Immunotherapy of Cancer.

^a For some neurologic, hematologic, and cardiac irAEs, ICI therapy should be discontinued at any grade of toxicity until the nature of the irAE and symptom progression is defined.