A patient on pembrolizumab develops grade 3 colitis (7 stools/day, severe abdominal pain) despite 2 days of high-dose intravenous methylprednisolone. What is the next recommended step?
- A Administer infliximab 5 mg/kg as a single dose ✓
- B Add oral mesalamine and continue steroids
- C Switch to oral prednisone and taper over 4 weeks
- D Initiate cyclosporine infusion
Correct answer: A. Administer infliximab 5 mg/kg as a single dose
Explanation
For steroid-refractory immune checkpoint inhibitor colitis, infliximab 5 mg/kg is the standard second-line therapy per ASCO and NCCN guidelines. It is effective in approximately 80% of steroid-refractory cases. Mesalamine has limited evidence. Cyclosporine is reserved for infliximab-refractory cases. Oral steroids are inadequate for grade 3 toxicity.
Reference: DeVita, Hellman, and Rosenberg's Cancer: Principles and Practice of Oncology, 12th ed.
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