Oral mucosal toxicities induced by immune checkpoint inhibitors: Clinical features and algorithm management

Area of Science:

• Oncology
• Immunology
• Dermatology

Background:

• Immune checkpoint inhibitors (ICIs) are increasingly used for advanced cancers.
• Immune-related adverse events (irAEs) are common, with dermatological reactions affecting 30-60% of patients.
• Oral mucosal adverse reactions to ICIs are less frequent than skin reactions but have emerged as a distinct clinical entity.

Approach:

• Systematic review of oral changes associated with ICI therapies.
• Analysis of characteristic oral manifestations, including lichenoid reactions, sicca syndrome, and autoimmune bullous disorders.
• Emphasis on clinical features and presentation, supported by detailed iconography.

Key Points:

• Oral adverse reactions to ICIs occur in up to 10% of patients, primarily within the first year of treatment.
• Common oral manifestations include lichenoid reactions, sicca syndrome, and autoimmune bullous disorders.
• Oral changes often coincide with cutaneous adverse events, highlighting systemic immune activation.

Conclusions:

• Oral mucosal adverse reactions are an important consideration in patients receiving ICI therapy.
• Recognition of these specific oral changes is crucial for timely diagnosis and management.
• Further research and clinical vigilance are needed to understand and mitigate ICI-induced oral toxicities.