Immune Checkpoint Inhibitor Diarrhea and Colitis Evaluation, Management, and Rechallenge

Authored by Natalia Gandur, published on 2026-10-27 21:49:38.0

  1. New diarrhea or suspected ICI colitis
    Assess diarrhea, colitis symptoms, severity, hydration, and clinical stability.
    • Any red-flag features?
      Check for severe pain, bleeding, fever, peritonitis, dehydration, or instability.
      • Urgent evaluation
        Escalate immediately for severe, unstable, or life-threatening presentation.
        • Check infection and alternative causes
          Obtain stool studies, laboratory testing, medication review, and clinical workup.
          • Determine ICI toxicity grade
            Classify suspected ICI-related diarrhea or colitis by clinical severity.
            • Continue ICI with supportive care
              Use hydration, dietary measures, and cautious symptom control for grade 1 toxicity.
              • Reassess Grade 1 symptoms
                Follow symptoms closely and escalate care if toxicity persists or worsens.
                • Continue or resume ICI with close monitoring
                  Restart treatment only when appropriate and monitor closely for recurrence.
                • Hold ICI; start oral corticosteroids for Grade 2
                  Hold ICI and complete diagnostic evaluation for moderate or severe toxicity.
                  • Clinical improvement without high-risk colitis features?
                    Assess symptoms and treatment response within the specified interval.
                    • Screen infection and contraindications; consider infliximab or vedolizumab
                      Initiate biologic therapy after evaluating contraindications and infection risk.
                      • Response after biologic?
                        Evaluate clinical response following infliximab or vedolizumab treatment.
                        • Confirm recovery and monitor for recurrence
                          Complete taper and review eligibility for restarting cancer immunotherapy.
                          • Rechallenge based on severity, ICI class, steroids, benefit
                            Review toxicity severity, recovery, cancer status, risks, and patient preference.
                            • Continue or resume ICI with close monitoring
                              Restart treatment only when appropriate and monitor closely for recurrence.
                            • Permanently discontinue ICI or do not rechallenge
                              Continue alternative cancer management without restarting the implicated ICI.
                          • Permanently discontinue ICI or do not rechallenge
                            Continue alternative cancer management without restarting the implicated ICI.
                        • Refer for refractory colitis or alternative diagnosis
                          Redirect persistent disease for specialist evaluation and alternative therapy.
                    • Taper corticosteroids and monitor
                      Taper gradually after improvement and continue surveillance for recurrence.
                      • Confirm recovery and monitor for recurrence
                        Complete taper and review eligibility for restarting cancer immunotherapy.
                        • Rechallenge based on severity, ICI class, steroids, benefit
                          Review toxicity severity, recovery, cancer status, risks, and patient preference.
                          • Continue or resume ICI with close monitoring
                            Restart treatment only when appropriate and monitor closely for recurrence.
                          • Permanently discontinue ICI or do not rechallenge
                            Continue alternative cancer management without restarting the implicated ICI.
                        • Permanently discontinue ICI or do not rechallenge
                          Continue alternative cancer management without restarting the implicated ICI.
                      • Screen infection and contraindications; consider infliximab or vedolizumab
                        Initiate biologic therapy after evaluating contraindications and infection risk.
                        • Response after biologic?
                          Evaluate clinical response following infliximab or vedolizumab treatment.
                          • Confirm recovery and monitor for recurrence
                            Complete taper and review eligibility for restarting cancer immunotherapy.
                            • Rechallenge based on severity, ICI class, steroids, benefit
                              Review toxicity severity, recovery, cancer status, risks, and patient preference.
                              • Continue or resume ICI with close monitoring
                                Restart treatment only when appropriate and monitor closely for recurrence.
                              • Permanently discontinue ICI or do not rechallenge
                                Continue alternative cancer management without restarting the implicated ICI.
                            • Permanently discontinue ICI or do not rechallenge
                              Continue alternative cancer management without restarting the implicated ICI.
                          • Refer for refractory colitis or alternative diagnosis
                            Redirect persistent disease for specialist evaluation and alternative therapy.
                • Hold ICI; manage Grade 3–4 colitis
                  Hospitalize and start IV corticosteroids for Grade 3–4; hold ICI for Grade 3 and permanently discontinue ICI for Grade 4.
                  • Clinical improvement without high-risk colitis features?
                    Assess symptoms and treatment response within the specified interval.
                    • Screen infection and contraindications; consider infliximab or vedolizumab
                      Initiate biologic therapy after evaluating contraindications and infection risk.
                      • Response after biologic?
                        Evaluate clinical response following infliximab or vedolizumab treatment.
                        • Confirm recovery and monitor for recurrence
                          Complete taper and review eligibility for restarting cancer immunotherapy.
                          • Rechallenge based on severity, ICI class, steroids, benefit
                            Review toxicity severity, recovery, cancer status, risks, and patient preference.
                            • Continue or resume ICI with close monitoring
                              Restart treatment only when appropriate and monitor closely for recurrence.
                            • Permanently discontinue ICI or do not rechallenge
                              Continue alternative cancer management without restarting the implicated ICI.
                          • Permanently discontinue ICI or do not rechallenge
                            Continue alternative cancer management without restarting the implicated ICI.
                        • Refer for refractory colitis or alternative diagnosis
                          Redirect persistent disease for specialist evaluation and alternative therapy.
                    • Taper corticosteroids and monitor
                      Taper gradually after improvement and continue surveillance for recurrence.
                      • Confirm recovery and monitor for recurrence
                        Complete taper and review eligibility for restarting cancer immunotherapy.
                        • Rechallenge based on severity, ICI class, steroids, benefit
                          Review toxicity severity, recovery, cancer status, risks, and patient preference.
                          • Continue or resume ICI with close monitoring
                            Restart treatment only when appropriate and monitor closely for recurrence.
                          • Permanently discontinue ICI or do not rechallenge
                            Continue alternative cancer management without restarting the implicated ICI.
                        • Permanently discontinue ICI or do not rechallenge
                          Continue alternative cancer management without restarting the implicated ICI.
                      • Screen infection and contraindications; consider infliximab or vedolizumab
                        Initiate biologic therapy after evaluating contraindications and infection risk.
                        • Response after biologic?
                          Evaluate clinical response following infliximab or vedolizumab treatment.
                          • Confirm recovery and monitor for recurrence
                            Complete taper and review eligibility for restarting cancer immunotherapy.
                            • Rechallenge based on severity, ICI class, steroids, benefit
                              Review toxicity severity, recovery, cancer status, risks, and patient preference.
                              • Continue or resume ICI with close monitoring
                                Restart treatment only when appropriate and monitor closely for recurrence.
                              • Permanently discontinue ICI or do not rechallenge
                                Continue alternative cancer management without restarting the implicated ICI.
                            • Permanently discontinue ICI or do not rechallenge
                              Continue alternative cancer management without restarting the implicated ICI.
                          • Refer for refractory colitis or alternative diagnosis
                            Redirect persistent disease for specialist evaluation and alternative therapy.
            • Hold ICI; start oral corticosteroids for Grade 2
              Hold ICI and complete diagnostic evaluation for moderate or severe toxicity.
              • Clinical improvement without high-risk colitis features?
                Assess symptoms and treatment response within the specified interval.
                • Screen infection and contraindications; consider infliximab or vedolizumab
                  Initiate biologic therapy after evaluating contraindications and infection risk.
                  • Response after biologic?
                    Evaluate clinical response following infliximab or vedolizumab treatment.
                    • Confirm recovery and monitor for recurrence
                      Complete taper and review eligibility for restarting cancer immunotherapy.
                      • Rechallenge based on severity, ICI class, steroids, benefit
                        Review toxicity severity, recovery, cancer status, risks, and patient preference.
                        • Continue or resume ICI with close monitoring
                          Restart treatment only when appropriate and monitor closely for recurrence.
                        • Permanently discontinue ICI or do not rechallenge
                          Continue alternative cancer management without restarting the implicated ICI.
                      • Permanently discontinue ICI or do not rechallenge
                        Continue alternative cancer management without restarting the implicated ICI.
                    • Refer for refractory colitis or alternative diagnosis
                      Redirect persistent disease for specialist evaluation and alternative therapy.
                • Taper corticosteroids and monitor
                  Taper gradually after improvement and continue surveillance for recurrence.
                  • Confirm recovery and monitor for recurrence
                    Complete taper and review eligibility for restarting cancer immunotherapy.
                    • Rechallenge based on severity, ICI class, steroids, benefit
                      Review toxicity severity, recovery, cancer status, risks, and patient preference.
                      • Continue or resume ICI with close monitoring
                        Restart treatment only when appropriate and monitor closely for recurrence.
                      • Permanently discontinue ICI or do not rechallenge
                        Continue alternative cancer management without restarting the implicated ICI.
                    • Permanently discontinue ICI or do not rechallenge
                      Continue alternative cancer management without restarting the implicated ICI.
                  • Screen infection and contraindications; consider infliximab or vedolizumab
                    Initiate biologic therapy after evaluating contraindications and infection risk.
                    • Response after biologic?
                      Evaluate clinical response following infliximab or vedolizumab treatment.
                      • Confirm recovery and monitor for recurrence
                        Complete taper and review eligibility for restarting cancer immunotherapy.
                        • Rechallenge based on severity, ICI class, steroids, benefit
                          Review toxicity severity, recovery, cancer status, risks, and patient preference.
                          • Continue or resume ICI with close monitoring
                            Restart treatment only when appropriate and monitor closely for recurrence.
                          • Permanently discontinue ICI or do not rechallenge
                            Continue alternative cancer management without restarting the implicated ICI.
                        • Permanently discontinue ICI or do not rechallenge
                          Continue alternative cancer management without restarting the implicated ICI.
                      • Refer for refractory colitis or alternative diagnosis
                        Redirect persistent disease for specialist evaluation and alternative therapy.
            • Hold ICI; manage Grade 3–4 colitis
              Hospitalize and start IV corticosteroids for Grade 3–4; hold ICI for Grade 3 and permanently discontinue ICI for Grade 4.
              • Clinical improvement without high-risk colitis features?
                Assess symptoms and treatment response within the specified interval.
                • Screen infection and contraindications; consider infliximab or vedolizumab
                  Initiate biologic therapy after evaluating contraindications and infection risk.
                  • Response after biologic?
                    Evaluate clinical response following infliximab or vedolizumab treatment.
                    • Confirm recovery and monitor for recurrence
                      Complete taper and review eligibility for restarting cancer immunotherapy.
                      • Rechallenge based on severity, ICI class, steroids, benefit
                        Review toxicity severity, recovery, cancer status, risks, and patient preference.
                        • Continue or resume ICI with close monitoring
                          Restart treatment only when appropriate and monitor closely for recurrence.
                        • Permanently discontinue ICI or do not rechallenge
                          Continue alternative cancer management without restarting the implicated ICI.
                      • Permanently discontinue ICI or do not rechallenge
                        Continue alternative cancer management without restarting the implicated ICI.
                    • Refer for refractory colitis or alternative diagnosis
                      Redirect persistent disease for specialist evaluation and alternative therapy.
                • Taper corticosteroids and monitor
                  Taper gradually after improvement and continue surveillance for recurrence.
                  • Confirm recovery and monitor for recurrence
                    Complete taper and review eligibility for restarting cancer immunotherapy.
                    • Rechallenge based on severity, ICI class, steroids, benefit
                      Review toxicity severity, recovery, cancer status, risks, and patient preference.
                      • Continue or resume ICI with close monitoring
                        Restart treatment only when appropriate and monitor closely for recurrence.
                      • Permanently discontinue ICI or do not rechallenge
                        Continue alternative cancer management without restarting the implicated ICI.
                    • Permanently discontinue ICI or do not rechallenge
                      Continue alternative cancer management without restarting the implicated ICI.
                  • Screen infection and contraindications; consider infliximab or vedolizumab
                    Initiate biologic therapy after evaluating contraindications and infection risk.
                    • Response after biologic?
                      Evaluate clinical response following infliximab or vedolizumab treatment.
                      • Confirm recovery and monitor for recurrence
                        Complete taper and review eligibility for restarting cancer immunotherapy.
                        • Rechallenge based on severity, ICI class, steroids, benefit
                          Review toxicity severity, recovery, cancer status, risks, and patient preference.
                          • Continue or resume ICI with close monitoring
                            Restart treatment only when appropriate and monitor closely for recurrence.
                          • Permanently discontinue ICI or do not rechallenge
                            Continue alternative cancer management without restarting the implicated ICI.
                        • Permanently discontinue ICI or do not rechallenge
                          Continue alternative cancer management without restarting the implicated ICI.
                      • Refer for refractory colitis or alternative diagnosis
                        Redirect persistent disease for specialist evaluation and alternative therapy.
          • Manage alternative cause and reassess
            Provide cause-directed management, monitoring, and reassessment without automatically initiating ICI-colitis-directed immunosuppression. If symptoms persist, worsen, or suggest concurrent immune-mediated colitis, reassess the diagnosis and severity.
      • Check infection and alternative causes
        Obtain stool studies, laboratory testing, medication review, and clinical workup.
        • Determine ICI toxicity grade
          Classify suspected ICI-related diarrhea or colitis by clinical severity.
          • Continue ICI with supportive care
            Use hydration, dietary measures, and cautious symptom control for grade 1 toxicity.
            • Reassess Grade 1 symptoms
              Follow symptoms closely and escalate care if toxicity persists or worsens.
              • Continue or resume ICI with close monitoring
                Restart treatment only when appropriate and monitor closely for recurrence.
              • Hold ICI; start oral corticosteroids for Grade 2
                Hold ICI and complete diagnostic evaluation for moderate or severe toxicity.
                • Clinical improvement without high-risk colitis features?
                  Assess symptoms and treatment response within the specified interval.
                  • Screen infection and contraindications; consider infliximab or vedolizumab
                    Initiate biologic therapy after evaluating contraindications and infection risk.
                    • Response after biologic?
                      Evaluate clinical response following infliximab or vedolizumab treatment.
                      • Confirm recovery and monitor for recurrence
                        Complete taper and review eligibility for restarting cancer immunotherapy.
                        • Rechallenge based on severity, ICI class, steroids, benefit
                          Review toxicity severity, recovery, cancer status, risks, and patient preference.
                          • Continue or resume ICI with close monitoring
                            Restart treatment only when appropriate and monitor closely for recurrence.
                          • Permanently discontinue ICI or do not rechallenge
                            Continue alternative cancer management without restarting the implicated ICI.
                        • Permanently discontinue ICI or do not rechallenge
                          Continue alternative cancer management without restarting the implicated ICI.
                      • Refer for refractory colitis or alternative diagnosis
                        Redirect persistent disease for specialist evaluation and alternative therapy.
                  • Taper corticosteroids and monitor
                    Taper gradually after improvement and continue surveillance for recurrence.
                    • Confirm recovery and monitor for recurrence
                      Complete taper and review eligibility for restarting cancer immunotherapy.
                      • Rechallenge based on severity, ICI class, steroids, benefit
                        Review toxicity severity, recovery, cancer status, risks, and patient preference.
                        • Continue or resume ICI with close monitoring
                          Restart treatment only when appropriate and monitor closely for recurrence.
                        • Permanently discontinue ICI or do not rechallenge
                          Continue alternative cancer management without restarting the implicated ICI.
                      • Permanently discontinue ICI or do not rechallenge
                        Continue alternative cancer management without restarting the implicated ICI.
                    • Screen infection and contraindications; consider infliximab or vedolizumab
                      Initiate biologic therapy after evaluating contraindications and infection risk.
                      • Response after biologic?
                        Evaluate clinical response following infliximab or vedolizumab treatment.
                        • Confirm recovery and monitor for recurrence
                          Complete taper and review eligibility for restarting cancer immunotherapy.
                          • Rechallenge based on severity, ICI class, steroids, benefit
                            Review toxicity severity, recovery, cancer status, risks, and patient preference.
                            • Continue or resume ICI with close monitoring
                              Restart treatment only when appropriate and monitor closely for recurrence.
                            • Permanently discontinue ICI or do not rechallenge
                              Continue alternative cancer management without restarting the implicated ICI.
                          • Permanently discontinue ICI or do not rechallenge
                            Continue alternative cancer management without restarting the implicated ICI.
                        • Refer for refractory colitis or alternative diagnosis
                          Redirect persistent disease for specialist evaluation and alternative therapy.
              • Hold ICI; manage Grade 3–4 colitis
                Hospitalize and start IV corticosteroids for Grade 3–4; hold ICI for Grade 3 and permanently discontinue ICI for Grade 4.
                • Clinical improvement without high-risk colitis features?
                  Assess symptoms and treatment response within the specified interval.
                  • Screen infection and contraindications; consider infliximab or vedolizumab
                    Initiate biologic therapy after evaluating contraindications and infection risk.
                    • Response after biologic?
                      Evaluate clinical response following infliximab or vedolizumab treatment.
                      • Confirm recovery and monitor for recurrence
                        Complete taper and review eligibility for restarting cancer immunotherapy.
                        • Rechallenge based on severity, ICI class, steroids, benefit
                          Review toxicity severity, recovery, cancer status, risks, and patient preference.
                          • Continue or resume ICI with close monitoring
                            Restart treatment only when appropriate and monitor closely for recurrence.
                          • Permanently discontinue ICI or do not rechallenge
                            Continue alternative cancer management without restarting the implicated ICI.
                        • Permanently discontinue ICI or do not rechallenge
                          Continue alternative cancer management without restarting the implicated ICI.
                      • Refer for refractory colitis or alternative diagnosis
                        Redirect persistent disease for specialist evaluation and alternative therapy.
                  • Taper corticosteroids and monitor
                    Taper gradually after improvement and continue surveillance for recurrence.
                    • Confirm recovery and monitor for recurrence
                      Complete taper and review eligibility for restarting cancer immunotherapy.
                      • Rechallenge based on severity, ICI class, steroids, benefit
                        Review toxicity severity, recovery, cancer status, risks, and patient preference.
                        • Continue or resume ICI with close monitoring
                          Restart treatment only when appropriate and monitor closely for recurrence.
                        • Permanently discontinue ICI or do not rechallenge
                          Continue alternative cancer management without restarting the implicated ICI.
                      • Permanently discontinue ICI or do not rechallenge
                        Continue alternative cancer management without restarting the implicated ICI.
                    • Screen infection and contraindications; consider infliximab or vedolizumab
                      Initiate biologic therapy after evaluating contraindications and infection risk.
                      • Response after biologic?
                        Evaluate clinical response following infliximab or vedolizumab treatment.
                        • Confirm recovery and monitor for recurrence
                          Complete taper and review eligibility for restarting cancer immunotherapy.
                          • Rechallenge based on severity, ICI class, steroids, benefit
                            Review toxicity severity, recovery, cancer status, risks, and patient preference.
                            • Continue or resume ICI with close monitoring
                              Restart treatment only when appropriate and monitor closely for recurrence.
                            • Permanently discontinue ICI or do not rechallenge
                              Continue alternative cancer management without restarting the implicated ICI.
                          • Permanently discontinue ICI or do not rechallenge
                            Continue alternative cancer management without restarting the implicated ICI.
                        • Refer for refractory colitis or alternative diagnosis
                          Redirect persistent disease for specialist evaluation and alternative therapy.
          • Hold ICI; start oral corticosteroids for Grade 2
            Hold ICI and complete diagnostic evaluation for moderate or severe toxicity.
            • Clinical improvement without high-risk colitis features?
              Assess symptoms and treatment response within the specified interval.
              • Screen infection and contraindications; consider infliximab or vedolizumab
                Initiate biologic therapy after evaluating contraindications and infection risk.
                • Response after biologic?
                  Evaluate clinical response following infliximab or vedolizumab treatment.
                  • Confirm recovery and monitor for recurrence
                    Complete taper and review eligibility for restarting cancer immunotherapy.
                    • Rechallenge based on severity, ICI class, steroids, benefit
                      Review toxicity severity, recovery, cancer status, risks, and patient preference.
                      • Continue or resume ICI with close monitoring
                        Restart treatment only when appropriate and monitor closely for recurrence.
                      • Permanently discontinue ICI or do not rechallenge
                        Continue alternative cancer management without restarting the implicated ICI.
                    • Permanently discontinue ICI or do not rechallenge
                      Continue alternative cancer management without restarting the implicated ICI.
                  • Refer for refractory colitis or alternative diagnosis
                    Redirect persistent disease for specialist evaluation and alternative therapy.
              • Taper corticosteroids and monitor
                Taper gradually after improvement and continue surveillance for recurrence.
                • Confirm recovery and monitor for recurrence
                  Complete taper and review eligibility for restarting cancer immunotherapy.
                  • Rechallenge based on severity, ICI class, steroids, benefit
                    Review toxicity severity, recovery, cancer status, risks, and patient preference.
                    • Continue or resume ICI with close monitoring
                      Restart treatment only when appropriate and monitor closely for recurrence.
                    • Permanently discontinue ICI or do not rechallenge
                      Continue alternative cancer management without restarting the implicated ICI.
                  • Permanently discontinue ICI or do not rechallenge
                    Continue alternative cancer management without restarting the implicated ICI.
                • Screen infection and contraindications; consider infliximab or vedolizumab
                  Initiate biologic therapy after evaluating contraindications and infection risk.
                  • Response after biologic?
                    Evaluate clinical response following infliximab or vedolizumab treatment.
                    • Confirm recovery and monitor for recurrence
                      Complete taper and review eligibility for restarting cancer immunotherapy.
                      • Rechallenge based on severity, ICI class, steroids, benefit
                        Review toxicity severity, recovery, cancer status, risks, and patient preference.
                        • Continue or resume ICI with close monitoring
                          Restart treatment only when appropriate and monitor closely for recurrence.
                        • Permanently discontinue ICI or do not rechallenge
                          Continue alternative cancer management without restarting the implicated ICI.
                      • Permanently discontinue ICI or do not rechallenge
                        Continue alternative cancer management without restarting the implicated ICI.
                    • Refer for refractory colitis or alternative diagnosis
                      Redirect persistent disease for specialist evaluation and alternative therapy.
          • Hold ICI; manage Grade 3–4 colitis
            Hospitalize and start IV corticosteroids for Grade 3–4; hold ICI for Grade 3 and permanently discontinue ICI for Grade 4.
            • Clinical improvement without high-risk colitis features?
              Assess symptoms and treatment response within the specified interval.
              • Screen infection and contraindications; consider infliximab or vedolizumab
                Initiate biologic therapy after evaluating contraindications and infection risk.
                • Response after biologic?
                  Evaluate clinical response following infliximab or vedolizumab treatment.
                  • Confirm recovery and monitor for recurrence
                    Complete taper and review eligibility for restarting cancer immunotherapy.
                    • Rechallenge based on severity, ICI class, steroids, benefit
                      Review toxicity severity, recovery, cancer status, risks, and patient preference.
                      • Continue or resume ICI with close monitoring
                        Restart treatment only when appropriate and monitor closely for recurrence.
                      • Permanently discontinue ICI or do not rechallenge
                        Continue alternative cancer management without restarting the implicated ICI.
                    • Permanently discontinue ICI or do not rechallenge
                      Continue alternative cancer management without restarting the implicated ICI.
                  • Refer for refractory colitis or alternative diagnosis
                    Redirect persistent disease for specialist evaluation and alternative therapy.
              • Taper corticosteroids and monitor
                Taper gradually after improvement and continue surveillance for recurrence.
                • Confirm recovery and monitor for recurrence
                  Complete taper and review eligibility for restarting cancer immunotherapy.
                  • Rechallenge based on severity, ICI class, steroids, benefit
                    Review toxicity severity, recovery, cancer status, risks, and patient preference.
                    • Continue or resume ICI with close monitoring
                      Restart treatment only when appropriate and monitor closely for recurrence.
                    • Permanently discontinue ICI or do not rechallenge
                      Continue alternative cancer management without restarting the implicated ICI.
                  • Permanently discontinue ICI or do not rechallenge
                    Continue alternative cancer management without restarting the implicated ICI.
                • Screen infection and contraindications; consider infliximab or vedolizumab
                  Initiate biologic therapy after evaluating contraindications and infection risk.
                  • Response after biologic?
                    Evaluate clinical response following infliximab or vedolizumab treatment.
                    • Confirm recovery and monitor for recurrence
                      Complete taper and review eligibility for restarting cancer immunotherapy.
                      • Rechallenge based on severity, ICI class, steroids, benefit
                        Review toxicity severity, recovery, cancer status, risks, and patient preference.
                        • Continue or resume ICI with close monitoring
                          Restart treatment only when appropriate and monitor closely for recurrence.
                        • Permanently discontinue ICI or do not rechallenge
                          Continue alternative cancer management without restarting the implicated ICI.
                      • Permanently discontinue ICI or do not rechallenge
                        Continue alternative cancer management without restarting the implicated ICI.
                    • Refer for refractory colitis or alternative diagnosis
                      Redirect persistent disease for specialist evaluation and alternative therapy.
        • Manage alternative cause and reassess
          Provide cause-directed management, monitoring, and reassessment without automatically initiating ICI-colitis-directed immunosuppression. If symptoms persist, worsen, or suggest concurrent immune-mediated colitis, reassess the diagnosis and severity.
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