{"doi":"10.3389/fonc.2025.1613552","title":"Case Report: Dupilumab therapy for immune checkpoint inhibitor-induced bullous pemphigoid enables dual immunotherapy initiation in progressive malignant melanoma","abstract":"<jats:p>Immune checkpoint inhibitors (ICIs) targeting PD-1, PD-L1 and CTLA-4 have transformed the treatment of malignant melanoma, significantly improving patient survival rates. However, these therapies often result in immune-related adverse events, with cutaneous toxicities being the most prevalent. One such irAE is bullous pemphigoid (BP), which is rare but challenging, and is characterised by autoantibody-mediated blistering at the dermo-epidermal junction. ICI-induced bullous pemphigoid (irBP) affects around 0.6% of patients and presents a therapeutic challenge as it requires the management of both the autoimmune response and the underlying malignancy. Recent research has highlighted the role of Th2 cytokines, particularly interleukin-4 (IL-4) and IL-13, and eosinophils in the pathogenesis of BP and irBP. Dupilumab, a monoclonal antibody that targets the IL-4 receptor alpha subunit, inhibits IL-4 and IL-13 signalling. In this report, we present a case of irBP in a patient with metastatic melanoma who was successfully treated with Dupilumab. Following resolution of the autoimmune skin toxicity, the patient was re-challenged with dual ICI therapy (Nivolumab and Ipilimumab), which remains the recommended first-line treatment for metastatic melanoma. This case highlights the potential of Dupilumab as a steroid-sparing option in the management of irBP, enabling continued oncological treatment.</jats:p>","journal":"Frontiers in Oncology","year":2025,"id":639098,"datarank":0.3453877639491069,"base_score":2.302585092994046,"endowment":2.302585092994046,"self_citation_contribution":0.3453877639491069,"citation_network_contribution":0.0,"self_endowment_contribution":0.3453877639491069,"citer_contribution":0.0,"corpus_percentile":null,"corpus_rank":null,"citation_count":9,"citer_count":0,"citers_with_citation_signal":0,"citers_with_endowment":0,"datacite_reuse_total":0,"is_dataset":false,"is_dataset_confidence":null,"is_data_producer":false,"deposit_databanks":null,"is_oa":false,"file_count":0,"downloads":0,"has_version_chain":false,"published_date":null,"fair_score":null,"fair_percentile":null,"algorithm_id":"datarank_citation_only_1hop_v6","ranking_scope":"data_only","authors":[{"id":1660297,"name":"Saskia Lehr","orcid":null,"position":1,"is_corresponding":false},{"id":1660299,"name":"Frank Meiss","orcid":null,"position":2,"is_corresponding":false},{"id":1660301,"name":"David Rafei","orcid":null,"position":3,"is_corresponding":false},{"id":644722,"name":"Franziska Schauer","orcid":"0000-0001-5147-0123","position":4,"is_corresponding":false},{"id":1660295,"name":"Janine Grüninger","orcid":null,"position":0,"is_corresponding":false}],"reference_count":0,"raw_metadata":{"has_enrichment":true,"resolved":true,"title":"Case Report: Dupilumab therapy for immune checkpoint inhibitor-induced bullous pemphigoid enables dual immunotherapy initiation in progressive malignant melanoma","abstract":"<jats:p>Immune checkpoint inhibitors (ICIs) targeting PD-1, PD-L1 and CTLA-4 have transformed the treatment of malignant melanoma, significantly improving patient survival rates. However, these therapies often result in immune-related adverse events, with cutaneous toxicities being the most prevalent. One such irAE is bullous pemphigoid (BP), which is rare but challenging, and is characterised by autoantibody-mediated blistering at the dermo-epidermal junction. ICI-induced bullous pemphigoid (irBP) affects around 0.6% of patients and presents a therapeutic challenge as it requires the management of both the autoimmune response and the underlying malignancy. Recent research has highlighted the role of Th2 cytokines, particularly interleukin-4 (IL-4) and IL-13, and eosinophils in the pathogenesis of BP and irBP. Dupilumab, a monoclonal antibody that targets the IL-4 receptor alpha subunit, inhibits IL-4 and IL-13 signalling. In this report, we present a case of irBP in a patient with metastatic melanoma who was successfully treated with Dupilumab. Following resolution of the autoimmune skin toxicity, the patient was re-challenged with dual ICI therapy (Nivolumab and Ipilimumab), which remains the recommended first-line treatment for metastatic melanoma. This case highlights the potential of Dupilumab as a steroid-sparing option in the management of irBP, enabling continued oncological treatment.</jats:p>","is_dataset_classified":null,"base_score":2.302585092994046,"endowment":2.302585092994046,"datacite_reuse_total":0,"file_count":0,"downloads":0,"views":0,"has_version_chain":false,"is_dataset":false,"is_oa":false,"pmid":"41079106","pmcid":"PMC12507624","openalex_id":"https://openalex.org/W4414520986","authors":[],"funders":[],"total_grants":0,"fwci":7.0876,"citation_percentile":0.97640823,"influential_citations":0,"citation_trend":[{"year":2025,"count":3},{"year":2026,"count":6}],"oa_status":"gold","license":"cc-by","oa_locations":[{"url":"https://www.frontiersin.org/journals/oncology/articles/10.3389/fonc.2025.1613552/pdf","host_type":"journal"},{"url":"https://www.frontiersin.org/journals/oncology/articles/10.3389/fonc.2025.1613552/pdf","host_type":"publisher"},{"url":"https://www.frontiersin.org/articles/10.3389/fonc.2025.1613552/full","host_type":"publisher"},{"url":"https://doi.org/10.3389/fonc.2025.1613552","host_type":"journal"},{"url":"https://pubmed.ncbi.nlm.nih.gov/41079106","host_type":"repository"},{"url":"https://doaj.org/article/9441e0d675754f618715a437ae582728","host_type":"repository"},{"url":"https://www.ncbi.nlm.nih.gov/pmc/articles/12507624","host_type":"repository"},{"url":"https://freidok.uni-freiburg.de/data/272939","host_type":"repository"},{"url":"https://pmc.ncbi.nlm.nih.gov/articles/PMC12507624/","host_type":"repository"},{"url":"https://europepmc.org/articles/PMC12507624","host_type":"Europe_PMC"},{"url":"https://europepmc.org/articles/PMC12507624?pdf=render","host_type":"Europe_PMC"}],"fields_of_study":["Autoimmune Bullous Skin Diseases","Coagulation, Bradykinin, Polyphosphates, and Angioedema","Cancer Immunotherapy and Biomarkers"],"mesh_terms":[],"keywords":["Bullous pemphigoid","Dupilumab","Immunotherapy","Melanoma","Pemphigoid","Monoclonal antibody","Adverse effect","Metastatic melanoma","Malignant melanoma","eosinophilia","Nras","Immune Checkpoint Inhibitor","Th2 (Type 2) Immune Responses"],"sdg_mappings":[],"linked_datasets":[],"clinical_trials":[],"software_tools":[],"database_accessions":[],"source":"live","citation_network_status":"fetched"},"created_at":"2026-08-06T22:28:55.772131Z","pmid":null,"pmcid":null,"fwci":null,"citation_percentile":null,"influential_citations":0,"oa_status":null,"license":null,"views":0,"total_file_size_bytes":0,"version_count":0,"fair_f":null,"fair_a":null,"fair_i":null,"fair_r":null,"fair_zscore":null,"fair_rationale":null,"fair_model":null,"fair_agent_version":null,"fair_fulltext_source":null,"fair_has_llm":null,"fair_computed_at":null,"clinical_trials":[],"software_tools":[],"db_accessions":[],"linked_datasets":[],"topics":[]}