What is your preferred steroid sparing therapy in a patient experiencing a severe checkpoint inhibitor toxicity and not responding to high dose IV steroids?

There are likely two different questions here:

1) For patients who have responded to steroids, but are unable to taper off (or to a minimally acceptable chronic dose), I have favored mycophenolate as a steroid sparing agent.

2) For patients with severe pneumonitis that is refractory to steroid ther...

This is a situation that needs to be tailored on an individual basis, especially taking into account the underlying cancer type. I prefer IL-6 inhibitors if the underlying malignancy is melanoma and no other contraindications exist for their use.

In someone with a solid cancer, I might consider TNFi...