Treatment side effects

Question 1

What is the first-line treatment for radiation proctitis?
And the second-line treatment?

Answer 1

1. Hydrocortisone PR
2. Sucralfate enemas

Question 2

Neutropenic fever is most common in which patient population?

Answer 2

Those recently treated with chemotherapy

Question 3

What two medications are typically used in managing tumor lysis syndrome?

Answer 3

• Allopurinol
• Rasburicase

Question 4

When a stable patient on ICI therapy comes in to the ED with new symptoms, what are some of the first steps of evaluation? And of management?

ICI = immune checkpoint inhibitor.

Answer 4

Evaluation
1. Rule out other causes
1. Grade severity

Management
1. Stop ICI
1. Start prednisone* at 1-2mg/Kg/day

*If not improving after a few days, consider adding additional agents.
NOTE: NCCN guidelines have section just for managing side effects of ICIs.

Question 5

List some of the (many) potential toxicities of ICI use.

Answer 5

• Encephalitis
• Myositis
• Myasthenia
• Myocarditis
• Hepatitis
• Pneumonitis
• Thyroiditis
• Hypophysitis
• Etc.