TABLE 6.

Management of pneumonitis in patients treated with immune checkpoint inhibitors (ICI) according to the American Society of Clinical Oncology (ASCO), European Society For Medical Oncology (ESMO) and Society for Immunotherapy of Cancer (SITC)

	ESMO [ 23 ]	ASCO [ 24 ]	SITC [ 25 ]
Grade 1
ICI management	Consider delay of treatment	Hold ICI	Consider holding ICI
Treatment	No specific treatment	No specific treatment	No specific treatment
Patient monitoring	Monitor symptoms every 2–3 days	Monitor patients weekly clinically One CT scan to be repeated in 3–4 weeks	Self-monitor symptoms and oxygen saturation every 2–3 days; weekly clinic visits Re-image at least prior to every cycle of ICI treatment
Drug re-challenge	Not specified	Yes, if radiographic evidence of improvement or resolution	Yes, with chest imaging abnormalities resolution
Grade 2
ICI management	Withhold ICI	Hold ICI	Hold ICI
Treatment	Prednisolone 1 mg·kg−1 per day−1 orally and taper over ≥6 weeks	Prednisone 1–2 mg·kg−1 per day−1 orally and taper over 4–6 weeks	Methylprednisolone 1 mg·kg−1 per day (i.v. or oral equivalent) and taper over ⩾4 weeks
Patient monitoring	Bronchoscopy and bronchioloalveolar lavage: optional Monitor symptoms daily/repeat chest radiography weekly/lung function tests including TLCO	Bronchoscopy with bronchial aspiration: optional Monitor every 3 days with history, physical examination and pulse oximetry, consider chest radiography	Bronchoscopy with bronchioloalveolar lavage: recommended Consider hospitalisation
Drug re-challenge	Not specified	Yes - if resolution to grade ≤1	Yes, if symptoms and imaging abnormalities resolve
Grade 3/4
ICI management	Discontinue ICI	Discontinue ICI	Discontinue ICI
Treatment	Empirical antibiotics/(methyl)prednisolone i.v. 2–4 mg·kg−1 per day−1; taper corticosteroids ⩾8 weeks If no improvement after 48 h, add infliximab 5 mg·kg−1 or mycophenolate mofetil	Empirical antibiotics/(methyl)prednisolone i.v. 1–2 mg·kg−1 per day; taper corticosteroids over 4–6 weeks If no improvement after 48 h, may add infliximab 5 mg·kg−1 or mycophenolate mofetil 1 g twice a day or i.v.-immunoglobulins for 5 days or cyclophosphamide	Methylprednisolone i.v., 2 mg·kg−1 per day; taper corticosteroids ⩾8 weeks If no improvement, add infliximab or cyclophosphamide, mycophenolate mofetil or i.v. immunoglobulins
Patient monitoring	Bronchoscopy and bronchioloalveoar lavage: optional Hospitalisation	Bronchoscopy with bronchioloalveolar lavage: recommended Hospitalisation	Bronchoscopy with bronchioloalveolar lavage: recommended Hospitalisation
Drug re-challenge	Not specified	No	Grade 3: case-by-case; only if symptoms and imaging abnormalities resolve Grade 4: no, discontinue ICI

CT: computed tomography; T_LCO: transfer factor of the lung for carbon monoxide.