Diagnosis and management of immune checkpoint inhibitor-induced dry mouth and salivary gland dysfunction in oncology patients: a systematic review.

To summarize diagnostic approaches and management strategies for dry mouth associated with immune checkpoint inhibitors (ICIs) in cancer patients. We conducted a systematic review following PRISMA guidelines (PROSPERO CRD420251267861). PubMed/MEDLINE, Scopus, Web of Science, and the Cochrane Library were searched from 2011 to 8 September 2025. We included original human studies reporting xerostomia, hyposalivation, or sicca syndrome attributed to ICIs. Two reviewers independently screened and extracted data. Risk of bias was assessed using the JBI Critical Appraisal Checklists for case reports and case series, and the Newcastle-Ottawa Scale for observational studies. Thirty-one studies published between 2016 and 2025 were included (17 case reports, 7 case series, and 7 observational studies), comprising 1,864 ICI-treated patients and 152 reported cases of xerostomia. Nivolumab and pembrolizumab were the most frequently implicated ICIs. Onset ranged from 5 days to 22 months after ICI initiation. Diagnostic evaluation was heterogeneous, variably using salivary gland imaging and objective salivary flow. Sjögren-related autoantibodies were usually absent. Management most commonly comprised systemic corticosteroids, sialagogues, topical saliva substitutes/stimulants, and temporary or permanent ICI discontinuation. Risk of bias was overall moderate, with few high-risk studies. The available evidence is largely based on case reports and case series and is heterogeneous, which limits its certainty. This review offers protocols for the correct diagnosis and treatment of ICI-related dry mouth and salivary gland dysfunction. Treatment with systemic corticosteroids appears to be effective, in many cases avoiding the need to interrupt treatment. Future standardized criteria and prospective studies are needed to improve the available evidence.