Management of Immune-Related Dermatitis and Mucositis Associated With Pembrolizumab in Metastatic Human Papillomavirus-Associated Squamous Cell Carcinoma of the Oropharynx.

Abstract

On June 10, 2019, the US Food and Drug Administration approved pembrolizumab for first-line treatment of metastatic or unresectable human papillomavirus (HPV)-positive and HPV-negative recurrent head and neck squamous cell carcinoma (HNSCC) based on the KEYNOTE-048 phase III study. Pembrolizumab is now the first anti-programmed cell death protein 1 (PD-1) therapy approved in the first-line HNSCC setting. Pembrolizumab is approved as first-line monotherapy for tumors that express programmed death-ligand 1 (PD-L1) or in combination with chemotherapy regardless of PD-L1 expression. As the indications for immunotherapy for HNSCC broaden, practitioners will need to know how to recognize and manage more immunotherapy-related toxicities. The following case study provides insight into the assessment and management of the specific immune-related toxicities of dermatitis and mucositis associated with pembrolizumab-chemotherapy combination therapy using Immuno-Oncology Essentials guidance. Assessment and early management of immunotherapy toxicity is critical, as is a multidisciplinary approach.