Immune-related adverse event and how we proceeded:
After one dose of ipilimumab + nivolumab, irHepatitis grade 1 (CTCAE) and irColitis grade 1 (CTCAE) occurred. The immunotherapy was interrupted. Initial therapy:
- Methylprednisolone 1 mg/kg bw
During an attempt to taper off the steroids, irColitis grade 2 (CTCAE) developed with diarrhea up to 7 times per day. Therapy:
- Methylprednisolone 1.5 mg/kg bw
- Infliximab 5 mg/kg bw i.v.
After this therapy, the patient was initially symptom-free. But when the steroids were tapered off, there was a recurrence of irColitis (grade 2) on 10 mg prednisolone. The patient had to be admitted to the hospital. Therapy:
- Methylprednisolone 1 mg/kg bw
- 2nd Dose of infliximab 5 mg/kg bw i.v.
- Start of extracorporeal photopheresis (ECP)
Initially, there was a further deterioration of the irColitis. The patient developed severe diarrhea, some with blood, fecal incontinence and dehydration (irColitis grade 4). Therapy:
- Methylprednisolone 2 mg/kg bw
- Continuation of extracorporeal photopheresis (weekly)
- Vedolizumab 300 mg i.v.
With this therapy, the symptoms improved over time. A second dose of vedolizumab was administered. The intervals of the ECP could be extended to every 2 weeks. Due to cerebral progress, stereotactic radiosurgery was repeated and chemotherapy with temozolomide 200 mg/m² was initiated.