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Vitiligo-like lesions in patients with advanced breast cancer treated with cycline-dependent kinases 4 and 6 inhibitors

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Abstract

Purpose

Introduction of cyclin-dependent inhibitors was a milestone in therapeutics for patients with estrogen receptor+/HER2− metastatic breast cancer. Despite the wide use of such agents and remarkable improvement of survival rates, drug-related adverse events are not yet fully characterized. We describe vitiligo-like lesions as a new adverse event occurring in patients with advanced breast cancer treated with cyclin-dependent inhibitors.

Methods

We performed an international retrospective study including patients with advanced breast cancer who developed vitiligo-like lesions during treatment with cyclin-dependent kinases 4 and 6 inhibitors, in the period January 2018–December 2019. Patients > 18 years, both males and females, were recruited at six Dermatology Departments located in Italy (3), France (1) and Greece (2). We evaluated epidemiological and clinical characteristics, impact on quality of life and outcome of vitiligo-like lesions in patients treated with cyclin-dependent 4 and 6 inhibitors. The percentage of skin involved by vitiligo-like lesions was assessed using the Body Surface Area (BSA) score. Changes in patients’ quality of life were investigated through the evaluation of the Dermatology Life Quality Index (DLQI) questionnaire.

Results

Sixteen women (median age: 62.5 years; range 40–79 years) treated with cyclin-dependent kinases 4 and 6 inhibitors for advanced breast cancer presented with vitiligo-like lesions during follow-up visits. Cutaneous lesions consisted of white, irregular macules and patches located mainly on sun-exposed areas in 11/16 patients or diffuse to the entire body surface in 5/16. Cutaneous lesions clearly impaired the quality of life of patients tested (DLQI ≥ 10).

Conclusions

We present for the first time, to our knowledge, a case series of vitiligo-like lesions developing in patients with advanced breast cancer treated with cyclin-dependent kinases 4 and 6 inhibitors. We showed that such lesions further impair the patients’ quality of life and their treatment is challenging.

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Acknowledgments

We sincerely thank the patients and their families for granting permission to publish this information. Alessandro Di Stefani, MD (Istituto di Dermatologia, Università Cattolica del Sacro Cuore, Rome, Italy), for his contribution to examine histopathology; Laurence Lamant, MD (Pathology Department, Institut Universitaire du cancer, Toulouse oncopole, France), for his assistance in immunohistochemistry. These contributors were not financially supported.

Author information

Authors and Affiliations

  1. UOC Dermatologia, Fondazione Policlinico Universitario A. Gemelli‐IRCCS, L.go Agostino Gemelli 8, 00168, Rome, Italy

    Pietro Sollena & Ketty Peris

  2. Dermato-Oncology Department, Cutaneous Toxicities Clinic, Andreas Sygros Hopital, National and Kapodistrian University of Athens, Athens, Greece

    Vasiliki Nikolaou, Dimitra Voudouri & Alexandros J. Stratigos

  3. Second Department of Medical Oncology, Agii Anargiri General Oncological Hospital of Kifissia, Athens, Greece

    Nikolaos Soupos

  4. Third Department of Medicine, Oncology Unit, Sotiria General HospitalNational and Kapodistrian University, Athens School of Medicine, Athens, Greece

    Elias Kotteas

  5. Section of Dermatology, Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples, Italy

    Davide Fattore, Maria Carmela Annunziata & Gabriella Fabbrocini

  6. Medical Oncology, Fondazione Policlinico Universitario A. Gemelli‐IRCCS, Rome, Italy

    Armando Orlandi

  7. Dermatologia,, Università Cattolica del Sacro Cuore, Rome, Italy

    Lucia Di Nardo & Ketty Peris

  8. Second Dermatology Department, Medical School, Aristotle University of Thessaloniki, Thessaloniki, Greece

    Zoe Apalla

  9. Oncodermatology Department, Institut Universitaire du Cancer, Toulouse Oncopole, Toulouse, France

    Florian Deilhes & Vincent Sibaud

  10. San Camillo Forlanini Hospital, Rome, Italy

    Maria Concetta Romano

Authors
  1. Pietro Sollena
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  2. Vasiliki Nikolaou
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  3. Nikolaos Soupos
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Consortia

the European Network for Cutaneous ADverse event of Oncologic drugs (ENCADO) group

Contributions

Dr P. Sollena and Dr N. Vasiliki had full access to all data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis. Concept and design: P. Sollena, N. Vasiliki, V. Sibaud. Acquisition, analysis, or interpretation of data: All authors. Drafting of the manuscript: P. Sollena, N. Vasiliki, K. Peris. Critical revision of the manuscript for important intellectual content: All authors. Statistical analysis: L. Di Nardo, D. Fattore. Administrative, technical, or material support: P. Sollena, N. Soupos, E. Kotteas, A. Orlandi. Supervision: V. Sibaud, K. Peris.

Corresponding author

Correspondence to Pietro Sollena.

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Conflict of interest

Pietro Sollena reports personal fees for presentations during dermatologic meetings from Leo Pharma, Novartis, Pierre Fabre, Sanofi and reports personal fee for Advisory Board meeting from Almirall, outside the submitted work. Vasiliki Nikolaou reports personal fees for Advisory Board meetings from Takeda, Ipsen and personal fees for presentations during dermatologic meetings from Bristol Meyers Squiibb, Amgen, Boehringer Ingelheim Pharma, Novartis, outside the submitted work. Nikolaos Soupos reports personal fees for presentations during oncologic conferences from Roche, Ipsen, BMS and for Advisory Board Meetings from Roche, outside the submitted work. Elias Kotteas has no conflict of interest to report. Dimitra Voudouri has no conflict of interest to report. Αlexander Stratigos reports honorarium fees and/or research support from Novartis, Roche, BMS, Abbvie, Sanofi, Regeneron, Genesis Pharma, outside the submitted work. Davide Fattore has no conflict of interest to report. Maria Carmela Annunziata reports personal fees for presentations during dermatologic meetings from AbbVie, outside the submitted work. Armando Orlandi reports personal fees for public speaching during oncologic meetings from Novartis, Amgen, Lilly, Roche and reports personal fee for Advisory Board Meetings from Novartis, Lilly, Amgen and Roche, outside the submitted work. Lucia Di Nardo has no conflict of interest to report. Zoe Apalla reports personal fees for Advisory Board Meetings from AbbVie, Leo Pharma, Novartis, and Janssen, outside the submitted work. Gabriella Fabbrocini reports personal fees for Advisory Board Meetings from Almirall, AbbVie, Difa Cooper, Biogen, Lilly, Celgene, Galderma, Leo Pharma, Novartis, Pierre Fabre, Sanofi, Sun Pharma and Janssen, outside the submitted work. Vincent Sibaud reports personal fees and honoraries for Advisory Board Meetings and symposia from Pierre Fabre, Novartis, BMS, Bayer, Sanofi outside the submitted work. Ketty Peris reports personal fees for Advisory Board Meetings from Almirall, AbbVie, Biogen, Lilly, Celgene, Galderma, Leo Pharma, Novartis, Pierre Fabre, Sanofi, Sandoz, Sun Pharma and Janssen, outside the submitted work.

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Sollena, P., Nikolaou, V., Soupos, N. et al. Vitiligo-like lesions in patients with advanced breast cancer treated with cycline-dependent kinases 4 and 6 inhibitors. Breast Cancer Res Treat 185, 247–253 (2021). https://doi.org/10.1007/s10549-020-05914-w

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