The panel discusses ipilimumab dosing and the management of immune-related toxicity with nivolumab plus ipilimumab in advanced hepatocellular carcinoma (HCC). The experts address whether clinicians should adhere to the trial dose of ipilimumab 3 mg/kg rather than a lower dose, explaining that earlier CheckMate data did not show an efficacy signal with lower ipilimumab dosing, supporting use of the protocol regimen. They emphasize vigilance during the first 6 months given the early-mortality signal, with close monitoring for pneumonitis, hepatitis, and adrenal insufficiency. The conversation then turns to steroid use and to treating patients with underlying autoimmune disease, with panelists describing how multidisciplinary collaboration with pulmonology, rheumatology, and hepatology has made immune checkpoint inhibitors feasible for selected patients whose autoimmune conditions are quiet and well controlled. James J. Harding, MD, and colleagues stress patient selection and early recognition of immune-related adverse events as central to the safe use of dual immunotherapy in HCC.
