Muhammad Ali Shazib1,2, Sook-Bin Woo1,2, Hervé Sroussi1,2, Ingrid Carvo1, Nathaniel Treister1,2, Arwa Farag3,4, Jonathan Schoenfeld5, Robert Haddad6, Nicole LeBoeuf7, Alessandro Villa1,2. 1. Department of Oral Medicine, Infection, and Immunity, Harvard School of Dental Medicine, Boston, MA, USA. 2. Division of Oral Medicine and Dentistry, Brigham and Women's Hospital and Dana-Farber Cancer Institute, Boston, MA, USA. 3. Department of Oral Diagnostic Sciences, Faculty of Dentistry, King Abdul Aziz University, Jeddah, Saudi Arabia. 4. Division of Oral Medicine, Tufts University School of Dental Medicine, Boston, MA, USA. 5. Department of Radiation Oncology, Dana- Farber Cancer Institute, Boston, MA, USA. 6. Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA. 7. Department of Dermatology, Brigham and Women's Hospital, Boston, MA, USA.
Abstract
OBJECTIVE: The aim of this study was to characterize clinical and histopathological features, and management outcomes of patients with oral immune-related adverse events (irAEs) secondary to programmed cell death-1 (PD-1) inhibitors. METHODS: This was a case series of cancer patients receiving PD-1 inhibitor therapy who were referred to oral medicine for the development of oral irAEs. Demographic, clinical, and histopathological data were collected from electronic medical records. RESULTS: There were 13 patients (7 males) with a median age of 68 years (range: 39-82) who were treated with nivolumab (n = 7) or pembrolizumab (n = 6). Oral irAEs included lichenoid lesions (n = 10), erythema multiforme (EM) (n = 2), and acute graft-versus-host disease reactivation (n = 1), with or without ulcerations (n = 8). Four patients (31%) presented with only oral irAEs. Oral biopsies showed lichenoid mucositis (n = 4). Management with topical and systemic steroids led to complete symptomatic response in most patients (n = 12). PD-1 inhibitor therapy was temporarily discontinued (n = 3) and discontinued indefinitely (n = 2) due to severe oral irAEs. CONCLUSION: Patients receiving PD-1 inhibitors may develop oral irAEs characterized by lichenoid lesions, ulcers, or EM. Topical and systemic steroids appear to be effective in managing oral lesions although the severity of irAEs may necessitate PD-1 inhibitor therapy dose modification.
OBJECTIVE: The aim of this study was to characterize clinical and histopathological features, and management outcomes of patients with oral immune-related adverse events (irAEs) secondary to programmed cell death-1 (PD-1) inhibitors. METHODS: This was a case series of cancerpatients receiving PD-1 inhibitor therapy who were referred to oral medicine for the development of oral irAEs. Demographic, clinical, and histopathological data were collected from electronic medical records. RESULTS: There were 13 patients (7 males) with a median age of 68 years (range: 39-82) who were treated with nivolumab (n = 7) or pembrolizumab (n = 6). Oral irAEs included lichenoid lesions (n = 10), erythema multiforme (EM) (n = 2), and acute graft-versus-host disease reactivation (n = 1), with or without ulcerations (n = 8). Four patients (31%) presented with only oral irAEs. Oral biopsies showed lichenoid mucositis (n = 4). Management with topical and systemic steroids led to complete symptomatic response in most patients (n = 12). PD-1 inhibitor therapy was temporarily discontinued (n = 3) and discontinued indefinitely (n = 2) due to severe oral irAEs. CONCLUSION:Patients receiving PD-1 inhibitors may develop oral irAEs characterized by lichenoid lesions, ulcers, or EM. Topical and systemic steroids appear to be effective in managing oral lesions although the severity of irAEs may necessitate PD-1 inhibitor therapy dose modification.
Authors: Brittany A Klein; Muhammad Ali Shazib; Alessandro Villa; Fábio de Abreu Alves; Piamkamon Vacharotayangul; Stephen Sonis; Stefano Fedele; Nathaniel S Treister Journal: Front Oral Health Date: 2022-08-11