Summary
Pembrolizumab is an immune checkpoint inhibitor (ICI) approved for multiple indications
in a variety of malignancies. Although generally well tolerated, the potential for
significant adverse effects, specifically immune related adverse effects (irAEs) needs
to be taken into consideration. Several cases of bullous pemphigoid have been reported
as a cutaneous adverse effect of ICIs since 2015, and there are recent reports of
mucous membrane pemphigoid (MMP). We present the case of an 84-year-old male with
metastatic urothelial carcinoma on treatment with pembrolizumab, who developed laryngeal
mucous membrane pemphigoid as an irAE. The diagnosis was based on patient's clinical
history and serologic testing, and supported by symptomatic improvement after ICI
discontinuation and immunosuppression. Pembrolizumab-induced MMP is a newly described
and infrequent irAE, requiring early suspicion and close monitoring for its diagnosis
and management.
Key Words
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to Journal of VoiceAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
REFERENCES
- Pembrolizumab alone or with chemotherapy for metastatic non-small-cell lung cancer: a systematic review and network meta-analysis.Crit Rev Oncol Hematol. 2022; 173103660https://doi.org/10.1016/j.critrevonc.2022.103660
- SEOM-SOGUG clinical guideline for localized muscle invasive and advanced bladder cancer (2021).Clin Transl Oncol. 2022; 24: 613-624https://doi.org/10.1007/s12094-022-02815-w
- Systematic literature review and network meta-analysis of pembrolizumab versus other interventions for previously untreated, unresectable or metastatic, MSI-high or MMR-deficient CRC.Futur Oncol. 2022; 18: 2155-2171https://doi.org/10.2217/fon-2021-1633
- Clinical benefits of PD-1/PD-L1 inhibitors in patients with metastatic colorectal cancer: a systematic review and meta-analysis.World J Surg Oncol. 2022; 20: 93https://doi.org/10.1186/s12957-022-02549-7
- Safety and efficacy of pembrolizumab with chemotherapy in locally advanced head and neck cancers.Oral Oncol. 2022; 127105824https://doi.org/10.1016/j.oraloncology.2022.105824
- Real-world effectiveness of immunotherapies in pre-treated, advanced non-small cell lung cancer Patients: a systematic literature review.Lung Cancer. 2022; 166: 205-220https://doi.org/10.1016/j.lungcan.2022.03.008
- Prescription patterns, recurrence, and toxicity rates of adjuvant treatment for stage III/IV melanoma—a real world single-center analysis.Biology (Basel). 2022; 11: 422https://doi.org/10.3390/biology11030422
- Epidemiology and risk factors for the development of cutaneous toxicities in patients treated with immune-checkpoint inhibitors: a United States population-level analysis.J Am Acad Dermatol. 2022; 86: 563-572https://doi.org/10.1016/j.jaad.2021.03.094
- Diagnosis, monitoring, and management of adverse events from immune checkpoint inhibitor therapy.Curr Oncol. 2020; 27: S43-S50https://doi.org/10.3747/co.27.5111
- Immune Checkpoint Proteins: Signaling Mechanisms and Molecular Interactions in Cancer Immunotherapy.Elsevier, 2022https://doi.org/10.1016/j.semcancer.2022.03.014
- Mucous membrane pemphigoid, bullous pemphigoid, and anti-programmed death-1/programmed death-ligand 1: a case report of an elderly woman with mucous membrane pemphigoid developing after pembrolizumab therapy for metastatic melanoma and review of the lite.Front Med. 2018; 5https://doi.org/10.3389/fmed.2018.00268
- Bullous pemphigoid in elderly woman affected by non-small cell lung cancer treated with pembrolizumab: a case report and review of literature.J Oncol Pharm Pract. 2021; 27: 727-733https://doi.org/10.1177/1078155220946370
- Immune-related adverse events associated with anti-PD-1/PD-L1 treatment for malignancies: a meta-analysis.Front Pharmacol. 2017; 8https://doi.org/10.3389/fphar.2017.00730
- Management of immune-related adverse events in patients treated with immune checkpoint inhibitor therapy: ASCO guideline update.J Clin Oncol. 2021; 39: 4073-4126https://doi.org/10.1200/JCO.21.01440
- Bullous pemphigoid associated with pembrolizumab therapy for non-small-cell lung cancer: a case report.Cureus. 2022; 14: 1-5https://doi.org/10.7759/cureus.21770
- Pembrolizumab-associated mucous membrane pemphigoid in a patient with Merkel cell carcinoma.Br J Dermatol. 2018; 179: 993-994https://doi.org/10.1111/bjd.16780
- A severe, refractory case of mucous membrane pemphigoid after treatment with pembrolizumab: brief communication.J Immunother. 2019; 42: 359-362https://doi.org/10.1097/CJI.0000000000000280
- Laryngeal pemphigoid evolution and response to treatment.J Voice. 2021; https://doi.org/10.1016/j.jvoice.2021.01.012
- Mucous membrane pemphigoid and lichenoid reactions after immune checkpoint inhibitors: common pathomechanisms.J Eur Acad Dermatology Venereol. 2020; 34: e112-e115https://doi.org/10.1111/jdv.16036
- Coexistence of oral mucous membrane pemphigoid and lichenoid drug reaction: a case of toripalimab-triggered and pembrolizumab-aggravated oral adverse events.Oral Surg Oral Med Oral Pathol Oral Radiol. 2021; 132: e86-e91https://doi.org/10.1016/j.oooo.2021.05.012
- Mucous membrane pemphigoid.Autoimmun Rev. 2022; 21103036https://doi.org/10.1016/j.autrev.2022.103036
- Epiglottitis as the presenting sign of mucous membranous pemphigoid: a case report.J Voice. 2018; 32: 101-103https://doi.org/10.1016/j.jvoice.2017.03.025
- Cummings Otolaryngology Head and Neck Surgery.7th ed. Elsevier, Philadelphia2021
- Gliptin accountability in mucous membrane pemphigoid induction in 24 Out of 313 patients.Front Immunol. 2018; 9https://doi.org/10.3389/fimmu.2018.01030
- Dermatologic reactions to immune checkpoint inhibitors.Am J Clin Dermatol. 2018; 19: 345-361https://doi.org/10.1007/s40257-017-0336-3
Pile HD, Yarrarapu SNS, Crane JS. Drug Induced Pemphigus. StatPearls. Available at: http://www.ncbi.nlm.nih.gov/pubmed/29110080. Published July 10, 2022.
- Skin biopsy: biopsy issues in specific diseases.J Am Acad Dermatol. 2016; 74: 1-16https://doi.org/10.1016/j.jaad.2015.06.033
- Laryngeal mucous membrane pemphigoid serves as a prognostic factor for poor response to treatment with rituximab.Clin Exp Dermatol. 2021; 46: 915-919https://doi.org/10.1111/ced.14662
- Association between immune-related adverse event timing and treatment outcomes.Oncoimmunology. 2022; 112017162https://doi.org/10.1080/2162402X.2021.2017162
Article info
Publication history
Published online: January 18, 2023
Accepted:
December 29,
2022
Publication stage
In Press Corrected ProofIdentification
Copyright
© 2023 The Voice Foundation. Published by Elsevier Inc. All rights reserved.
