Immune-Related Oral, Otologic, and Ocular Adverse Events

Akanksha Srivastava, Nagham Al-Zubidi, Eric Appelbaum, Dan S. Gombos, Marc Elie Nader, Paul W. Gidley, Mark S. Chambers

Research output: Chapter in Book/Report/Conference proceedingChapter

9 Scopus citations


Emerging immunotherapy agents, such as immune checkpoint inhibitors, have shown remarkable promise in the treatment of various malignancies. These drugs selectively target different steps in the immune response cascade to upregulate the body’s normal response to cancer. Due to the novelty of these therapeutic agents, their toxicity profile is less well understood. Meta-analysis results reveal that the overall prevalence of oral mucositis, stomatitis, and xerostomia is lower with checkpoint inhibitors compared to conventional chemotherapy, and head and neck radiation therapy. However, the widespread use of immunotherapy reveals new oral mucosal barrier adverse events, including bullous pemphigoid, mucous membrane pemphigoid, and lichenoid mucositis. Audiovestibular dysfunction can occur from autoimmune-mediated pathways of immunotherapy (adoptive cell) with limited treatment options. Such auditory complications can lead to speech recognition deficits and sensorineural hearing loss. Ocular toxicities are among the most common adverse events resulting from the use of these agents. The majority of ocular immune-related adverse events (irAEs) are mild, low-grade, non-sight threatening, such as blurred vision, conjunctivitis, and ocular surface disease. Serious and sight-threatening events, including corneal perforation, optic neuropathy, and retinal vascular occlusion, can occur but are infrequent. In this chapter, we review the current evidence on the clinical manifestations of oral, audiovestibular, and ocular immune-related adverse events (i.e., irAEs).

Original languageEnglish (US)
Title of host publicationAdvances in Experimental Medicine and Biology
Number of pages13
StateE-pub ahead of print - Apr 17 2020

Publication series

NameAdvances in Experimental Medicine and Biology
ISSN (Print)0065-2598
ISSN (Electronic)2214-8019


  • Anti-PD-1/PD-L1
  • Atezolizumab
  • CTLA-4
  • Checkpoint inhibitors
  • Hearing loss
  • Immune-related ocular toxicities
  • Immune-related oral toxicities
  • Immune-related otologic toxicities
  • Ipilimumab
  • Nivolumab
  • Ocular adverse events
  • Oral adverse events
  • Pembrolizumab

ASJC Scopus subject areas

  • Biochemistry, Genetics and Molecular Biology(all)


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