How do you prescribe a steroid taper for radiation and checkpoint inhibitor related pneumonitis?

Topics: Radiation Oncology • Pediatric Oncology • Thoracic Malignancies • Medical Oncology • Immunotherapy • Immune-related adverse events • Pulmonology • Pneumonitis

I've seen a handful of fatal radiation pneumonitis associated with rapid steroid tapers by the non-treating physicians. How do you recommend prescribing a taper to prevent this?

Answer from: Radiation Oncologist at Academic Institution

I subscribe to the philosophy of "hitting hard, tapering slowly" for cases of pneumonitis, either radiation pneumonitis, or checkpoint inhibitor-related pneumonitis (some of those cases probably have mixed origin, with contributions from radiation and/or checkpoint inhibitors). For severely symptom...

Comments

Radiation Oncologist at Yale School of Medicine
Thank you so much. I was always taught to go slow ...

Medical Oncologist at Yuma Regional Medical Center Cancer Center
As a rule of thumb, irAEs need a relatively long-t...

Radiation Oncologist at Yale School of Medicine
Thanks for this. I think decreasing the dose to 20...

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