Mucous Membrane Pemphigoid After Anti-PD-1 Therapy: Risk-Stratified Management and Treatment Outcomes.

Area of Science:

• Oncology
• Immunology
• Dermatology

Background:

• Mucous membrane pemphigoid (MMP) is a rare but emerging side effect of anti-programmed cell death-1 (PD-1) immunotherapy.
• Optimal management strategies and oncologic trade-offs for anti-PD-1-associated MMP are not well-defined.

Purpose of the Study:

• To synthesize published cases of anti-PD-1-associated MMP.
• To analyze management approaches and treatment outcomes.
• To evaluate the impact on cancer treatment continuation.

Main Methods:

• A narrative synthesis of published cases of anti-PD-1-associated MMP was performed.
• Searches were conducted in MEDLINE, Embase, and PubMed Central from January 2014 to June 2025.
• Fifteen cases from thirteen reports met the inclusion criteria.

Main Results:

• The median latency period for MMP was 12.5 weeks, with frequent oral mucosa involvement (84.6%).
• Doxycycline plus topical corticosteroids (TCS) achieved complete remission in all five low-risk patients treated.
• High-risk MMP required escalation with methotrexate, rituximab, and/or IVIg. Overall, 86.7% achieved complete or partial response (CR/PR).
• Tumor control was maintained in 72.7% of patients, with discontinuation of anti-PD-1 therapy not always necessary.

Conclusions:

• Anti-PD-1-associated MMP is typically oral-predominant with infrequent ocular involvement.
• Management should be tailored to risk stratification, with doxycycline and TCS effective for low-risk cases.
• Anti-PD-1 therapy can often be continued when clinically prioritized, using systemic steroids to manage MMP.