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Klein BA, Alves FA, de Santana Rodrigues Velho J, Vacharotayangul P, Hanna GJ, LeBoeuf NR, Shazib MA, Villa A, Woo SB, Sroussi H, Sonis S, Treister NS. Oral manifestations of immune-related adverse events in cancer patients treated with immune checkpoint inhibitors. Oral Dis 2021; 28:9-22. [PMID: 34265157 DOI: 10.1111/odi.13964] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2021] [Revised: 06/13/2021] [Accepted: 07/08/2021] [Indexed: 12/24/2022]
Abstract
Immunotherapy with immune checkpoint inhibitors (ICIs) has transformed cancer treatment over the past decade, improving survival rates in numerous advanced cancers. Immune-related adverse events (irAEs) are common and can affect any organ system, with many of these toxicities being well-characterized with clear grading criteria and management approaches. There has been less emphasis on oral manifestations of irAEs. This review provides an overview of oral manifestations of irAEs, including mucosal and salivary gland toxicities, and proposes a grading system and management guidelines. irAEs are common treatment-related toxicities in patients treated with ICIs. Oral irAEs can range from asymptomatic white reticulations to life-threatening mucocutaneous reactions requiring aggressive management with corticosteroids and/or permanent discontinuation of ICIs. Oral healthcare providers should be prepared to identify and manage oral irAEs in collaboration with oncologists and other specialists.
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Affiliation(s)
- Brittany A Klein
- Division of Oral Medicine and Dentistry, Brigham and Women's Hospital, Boston, MA, USA.,Harvard School of Dental Medicine, Boston, MA, USA
| | - Fábio Abreu Alves
- A.C. Camargo Cancer Center, São Paulo, Brazil.,University of São Paulo School of Dentistry, São Paulo, Brazil
| | | | - Piamkamon Vacharotayangul
- Division of Oral Medicine and Dentistry, Brigham and Women's Hospital, Boston, MA, USA.,Harvard School of Dental Medicine, Boston, MA, USA
| | - Glenn J Hanna
- Center for Head and Neck Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Nicole R LeBoeuf
- Department of Dermatology, Center for Cutaneous Oncology, Dana-Farber/Brigham and Women's Cancer Center, Harvard Medical School, Boston, MA, USA
| | - Muhammad Ali Shazib
- Division of Craniofacial and Surgical Care, University of North Carolina at Chapel Hill Adams School of Dentistry, Chapel Hill, NC, USA
| | - Alessandro Villa
- Department of Orofacial Sciences, University of California San Francisco, San Francisco, CA, USA
| | - Sook-Bin Woo
- Division of Oral Medicine and Dentistry, Brigham and Women's Hospital, Boston, MA, USA.,Harvard School of Dental Medicine, Boston, MA, USA
| | - Hervé Sroussi
- Division of Oral Medicine and Dentistry, Brigham and Women's Hospital, Boston, MA, USA.,Harvard School of Dental Medicine, Boston, MA, USA
| | - Stephen Sonis
- Division of Oral Medicine and Dentistry, Brigham and Women's Hospital, Boston, MA, USA.,Harvard School of Dental Medicine, Boston, MA, USA
| | - Nathaniel S Treister
- Division of Oral Medicine and Dentistry, Brigham and Women's Hospital, Boston, MA, USA.,Harvard School of Dental Medicine, Boston, MA, USA
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