LAUSR

BP: bullous pemphigoid irAE: immune-related adverse events PD-1: programmed cell death-1 PD-L1: programmed cell death ligand-1 TGF-b: transforming growth factor beta Treg: T regulatory cell INTRODUCTION Immune checkpoint inhibitors targeting the programmed cell death-1 receptor (PD-1) and the programmed cell death ligand-1 (anti-PD-L1) have emerged as effective therapies for some patients with unresectable cancers. However, by amplifying the body’s natural antitumor defenses, normal cells can be affected, resulting in autoimmune-like side effects. Cutaneous immune-related adverse events (irAEs) are observed in 39% to 49% of patients receiving anti-PD-1 therapy. Anti-PD-L/anti-PDL1-induced bullous disorders make up a rare but recognized class of cutaneous irAE. Bullous cutaneous irAEs requiring systemic treatment can cause delays in the delivery of cancer therapy, making prompt diagnosis and treatment essential to preventing undue morbidity and mortality. Despite the success of antibodies targeting PD-1/ PD-L1, many patients do not have an adequate response. This has led to the development of combination therapies, such as the addition of transforming growth factor beta (TGF-b). Upregulation of TGF-b signaling has been associated with immunosuppression in the tumor microenvironment and development of resistance following initial response to anti-PD-1/PD-L1 treatments for patients with metastatic melanoma and urothelial cancers. Bintrafusp alfa is a bifunctional fusion protein, which blocks PD-L1 and sequesters TGF-b from the systemic circulation via a TGF-bRII component, offering