- Mild symptoms
- Moderate symptoms, limiting instrumental ADLs
- Severe symptoms; limiting self-care ADLs
- Urgent intervention needed
Management
- New-onset (Grade 2-3) moderate to severe symptoms: rule out infectious or other causes; consult neurologist, obtain brain MRI and lumbar puncture
- For ipilimumab: Anticipate standard ipilimumab dosage holds/discontinuations; administer corticosteroids at dosage of 1-2 mg/kg/d prednisone equivalents (or 2-4 mg/kg if necessary)
- For nivolumab: Withhold nivolumab for new-onset moderate to severe neurologic symptoms; evaluate as described above; if other etiologies are ruled out, administer corticosteroids and permanently discontinue nivolumab for immune-mediated encephalopathy
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