The efficacy of relacorilant, a glucocorticoid antagonist, has raised concerns that routine steroid use with chemotherapy may induce resistance. This has led clinicians to reduce steroid doses, questioning a long-standing practice and its potential to blunt the therapeutic effects of chemotherapy.

Administering tocilizumab before the first bispecific antibody dose significantly reduces Cytokine Release Syndrome (CRS) risk. This proactive strategy enables safer outpatient treatment, lowering hospital admissions and improving patient access, especially in community settings.

Pulsed dexamethasone provides no overall response rate benefit compared to a standard prednisone taper in first-line ITP treatment. It may offer a slightly faster response (by about one day) but carries a higher risk of acute steroid complications, particularly psychosis in older adults.

Clinicians are far more cautious using immunotherapy in organ transplant recipients than in patients with autoimmune disease. The risk of irreversible graft rejection is a major deterrent, reserving checkpoint inhibitors only for when no other treatment options exist.

Though typically contraindicated, checkpoint inhibitors can be used for transplant recipients with advanced skin cancer. This requires shared decision-making, collaboration with the transplant team, and a specific protocol involving high-dose pulse steroids to mitigate the high risk of allograft rejection.

To mitigate organ rejection risk in transplant patients with CSCC, oncologists should coordinate with transplant teams to switch from drugs like tacrolimus to an mTOR inhibitor. This proactive switch can prevent rejection and may even enhance the immunotherapy's effectiveness.

Using checkpoint inhibitors in renal transplant recipients requires extreme caution due to a significant risk of graft rejection, potentially leading to dialysis. This decision is a major trade-off and must involve a case-by-case discussion with the patient and a nephrologist.

Unlike some immunotherapy guidelines, experts recommend immediate steroid treatment for even Grade 1 (asymptomatic) ADC-induced pneumonitis or interstitial lung disease (ILD) found on scans. This aggressive, proactive approach is considered necessary due to the risk of rapid clinical deterioration, prioritizing safety and the ability to resume cancer therapy.

Abruptly stopping JAK inhibitors can trigger a potentially fatal SIRS-like syndrome from a cytokine storm. Clinicians must taper the dose. If an abrupt stop is necessary (e.g., for a procedure), bridging the patient with prednisone is a critical and effective strategy to prevent this severe withdrawal reaction.