No, Krista, we have been fortunate enough that even our most severe cases of pneumonitis have responded to high dose steroids, but I could see how the thought consideration could come up.
I suppose that we may in that instance consider temsirolimus or another anti-rejection med, which would be utilized with a patient who had a lung transplant- like we do with mycophenalate & irAE related hepatitis.
Hi Krita–
We have utilized infliximab for a number of steroid-refractory immune related toxicities, including pneumonitis and myocarditis.
For hepatitis, we do not use infliximab and have used mycophenylate in the steroid-refractory setting.
Suzanne, you make a good point that infliximab should not be administered for immune hepatitis, in the literature, this is noted as a contraindication due to it’s own potential for hepatotoxicity.