Devita, Hellman, and Rosenberg's Cancer

LWBK1006-27 LWW-Govindan-Review December 12, 2011 19:32

382 DeVita, Hellman, and Rosenberg’s CANCER: Principles and Practice of Oncology Review

in order to rule out bowel perforation by clinical exam as well as any

potential infectious cause (stool Clostridium difficile toxin, ova, and par-

asites). Colonoscopy should be performed if there is a clinical concern or

uncertainty. Systemic corticosteroids are indicated in patients with grade

3 immune-mediated enterocolitis at a dose of 1 to 2 mg/kg/day of pred-

nisone or equivalent. Upon improvement to grade 1 or less, the steroids

should be tapered slowly over at least 1-month interval. In patients with

grade 3 or higher immune-mediated toxicity, the ipilimumab should be

permanently discontinued.