Should nivolumab be discontinued in a patient who develops bullous pemphigoid but is otherwise responding well to therapy, if BP is being managed with dupilumab?

Nivolumab should be discontinued in a patient with grade 3-4 bullous pemphigoid, but may be held rather than permanently discontinued for grade 2 disease, even when the bullous pemphigoid is being managed with dupilumab.

The National Comprehensive Cancer Network guidelines specify that discontinuation of immunotherapy is warranted for severe or life-threatening bullous disease (grade 3-4). Grade 3 bullous pemphigoid is defined as blisters covering >30% body surface area (BSA), limiting self-care activities of daily living, while grade 4 involves blisters covering >30% BSA with fluid or electrolyte abnormalities requiring ICU or burn unit care.

For moderate (grade 2) bullous pemphigoid (blisters covering 10-30% BSA with painful blisters limi...