TABLE 3.

Management of CIP.

Grades	Guideline for the management
G1	• Consider holding ICIs Monitor symptoms every 2–3 days
	• May offer one repeat CT in 3–4 weeks
	• In patients who have had baseline testing, may offer a repeat spirometry/DLCO in 3–4 weeks
	○ If improvement is observed, continue to follow up
	○ If condition worsens, treat as G2 or 3–4
G2	• Hold ICIs until resolution to G1 or less
	• Consider infectious workup: nasal swab for potential viral pathogens sputum culture, blood culture, and urine culture
	• Consider chest CT with contrast Repeat chest CT in 3–4 weeks
	• Consider empirical antibiotics if infection has not yet been fully excluded
	• Prednisone IV 1–2 mg/kg/day
	○ If improvement is observed, start slow steroid taper by 5 to 10 mg/week over 4 to 6 weeks
	○ If condition worsens, treat as G3–4
G3/G4	• Permanently discontinue ICIs
	• Pulmonary consultation for bronchoscopy with BAL
	Consider biopsies for atypical lesions Methylprednisolone IV 2–4 mg/kg/day
	○ If improvement is observed, taper corticosteroids over 4–6 weeks
	○ If not improving or worsening after 48 h: add infliximab IV 5 mg/kg
	or MMF IV 1 g BID
	or IVIG for 5 days
	or cyclophosphamide

ICIs, immune checkpoint inhibitors; CT, computed tomography; DLCO, carbon monoxide diffusing capacity; IV, intravenous; BAL, bronchoalveolar lavage; MMF, mycophenolate mofetil; BID, two times daily; and IVIG, intravenous immunoglobulin.