Skip to main content

Advertisement

SpringerLink
Log in

Immune checkpoint inhibitor-induced vitiligo in cancer patients: characterization and management

  • ORIGINAL PAPER
  • Published:
Archives of Dermatological Research Aims and scope Submit manuscript

Abstract

This study highlights the range of non-melanoma cancers where ICI-induced vitiligo can be present and challenges the exclusivity of this phenomenon to melanoma. We believe our manuscript will encourage awareness in our colleagues and stimulate interest in further studies to elucidate the mechanisms of ICI-induced vitiligo in both melanoma and non-melanoma cancers, and to understand whether this phenomenon holds the same positive prognostic value in both cancer groups. This is a retrospective cohort study from a single-institution’s electronic medical record for cancer patients treated with ICIs who subsequently developed vitiligo. We identified 151 patients with ICI-induced vitiligo, 19 (12.6%) non-melanoma and 132 (77.4%) melanoma patients. Time to onset of vitiligo was nearly doubled in the non-melanoma cohort, however, this is confounded by possible delayed diagnosis or under reporting of this asymptomatic condition in patients who do not regularly receive skin exams. The majority of patients had a stable course of vitiligo with 91.4% receiving no treatment in this largely Caucasian cohort. Two patients with non-melanoma cancers and Fitzpatrick type IV or above skin received treatment with narrowband ultraviolet B light therapy and topical steroids with near-complete response. This study highlights the occurrence of ICI-induced vitiligo in a variety of non-melanoma cancers, where skin of color patients will be more prevalent and the need for treatment will potentially be more urgent. Further study is needed to elucidate the mechanism of ICI-induced vitiligo and determine if non-melanoma cancers have the same association between vitiligo and increased tumor response.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

Data availability

De-identified data is available upon request.

References

  1. Geisler AN, Phillips GS, Barrios DM et al (2020) Immune checkpoint inhibitor-related dermatologic adverse events. J Am Acad Dermatol 83(5):1255–1268. https://doi.org/10.1016/j.jaad.2020.03.132

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  2. Failla CM, Carbone ML, Fortes C, Pagnanelli G, D’Atri S (2019) Melanoma and vitiligo in: good company. Int J Mol Sci 20(22):5731. https://doi.org/10.3390/ijms20225731

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  3. Lolli C, Medri M, Ricci M et al (2018) Vitiligo-like lesions in a patient treated with nivolumab for renal cell carcinoma. Medicine (Baltimore) 97(52):e13810. https://doi.org/10.1097/MD.0000000000013810

    Article  PubMed  Google Scholar 

  4. Liu RC, Consuegra G, Chou S, Fernandez Peñas P (2019) Vitiligo-like depigmentation in oncology patients treated with immunotherapies for nonmelanoma metastatic cancers. Clin Exp Dermatol 44(6):643–646. https://doi.org/10.1111/ced.13867

    Article  CAS  PubMed  Google Scholar 

  5. Uenami T, Hosono Y, Ishijima M et al (2017) Vitiligo in a patient with lung adenocarcinoma treated with nivolumab: a case report. Lung Cancer 109:42–44. https://doi.org/10.1016/j.lungcan.2017.04.019

    Article  PubMed  Google Scholar 

  6. Bulat V, Likic R, Bradic L, Speeckaert R, Azdajic MD (2021) Pembrolizumab-induced vitiligo in a patient with lung adenocarcinoma: a case report. Br J Clin Pharmacol 87(6):2614–2618. https://doi.org/10.1111/bcp.14663

    Article  CAS  PubMed  Google Scholar 

  7. Kosche C, Mohindra N, Choi JN (2018) Vitiligo in a patient undergoing nivolumab treatment for non-small cell lung cancer. JAAD Case Rep 4(10):1042–1044. https://doi.org/10.1016/j.jdcr.2018.08.009

    Article  PubMed  PubMed Central  Google Scholar 

  8. Rodríguez-Lomba E, Molina-López I, Suárez-Fernández R, Baniandrés-Rodríguez O (2018) Vitiligo-like lesions and immune checkpoint inhibition therapy: is it truly an adverse event exclusive to patients with melanoma? Clin Exp Dermatol 43(5):598–599. https://doi.org/10.1111/ced.13382

    Article  PubMed  Google Scholar 

  9. Hua C, Boussemart L, Mateus C et al (2016) Association of vitiligo with tumor response in patients with metastatic melanoma treated with pembrolizumab. JAMA Dermatol 152(1):45. https://doi.org/10.1001/jamadermatol.2015.2707

    Article  PubMed  Google Scholar 

  10. Teulings H-E, Limpens J, Jansen SN et al (2015) Vitiligo-like depigmentation in patients with stage iii–iv melanoma receiving immunotherapy and its association with survival: a systematic review and meta-analysis. JCO 33(7):773–781. https://doi.org/10.1200/JCO.2014.57.4756

    Article  CAS  Google Scholar 

  11. Freeman-keller M, Kim Y, Cronin H, Richards A, Gibney G, Weber JS (2016) Nivolumab in resected and unresectable metastatic melanoma: characteristics of immune-related adverse events and association with outcomes. Clin Cancer Res 22(4):886–894

    Article  CAS  PubMed  Google Scholar 

  12. Villadolid J, Amin A (2015) Immune checkpoint inhibitors in clinical practice: update on management of immune-related toxicities. Transl Lung Cancer Res 4(5):560–575

    CAS  PubMed  PubMed Central  Google Scholar 

  13. Quaglino P, Marenco F, Osella-Abate S et al (2010) Vitiligo is an independent favourable prognostic factor in stage III and IV metastatic melanoma patients: results from a single-institution hospital-based observational cohort study. Ann Oncol 21(2):409–414. https://doi.org/10.1093/annonc/mdp325

    Article  CAS  PubMed  Google Scholar 

  14. Karri PV, Tahseen D, Patel AB (2020) Treatment of checkpoint inhibitor-induced vitiligo in a patient with metastatic renal cell cancer. Dermatitis. https://doi.org/10.1097/DER.0000000000000670

    Article  Google Scholar 

  15. Grimes PE, Miller MM (2018) Vitiligo: patient stories, self-esteem, and the psychological burden of disease. Int J Womens Dermatol 4(1):32–37. https://doi.org/10.1016/j.ijwd.2017.11.005

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  16. Seneschal J, Harris JE, Le Poole IC, Passeron T, Speeckaert R, Boniface K (2021) Editorial: immunology of vitiligo. Front Immunol 12:711080

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  17. Hodi FS, Chesney J, Pavlick AC et al (2016) Combined nivolumab and ipilimumab versus ipilimumab alone in patients with advanced melanoma: 2-year overall survival outcomes in a multicentre, randomised, controlled, phase 2 trial. Lancet Oncol 17:1558–1568. https://doi.org/10.1016/S1470-2045(16)30366-7

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  18. Larkin J, Chiarion-Sileni V, Gonzalez R et al (2019) Five-year survival with combined nivolumab and ipilimumab in advanced melanoma. N Engl J Med 381(16):1535–1546. https://doi.org/10.1056/NEJMoa1910836

    Article  CAS  PubMed  Google Scholar 

  19. Topalian SL, Sznol M, McDermott DF et al (2014) Survival, durable tumor remission, and long-term safety in patients with advanced melanoma receiving nivolumab. J Clin Oncol 32(10):1020–1030. https://doi.org/10.1200/JCO.2013.53.0105

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  20. Robert C, Schachter J, Long GV et al (2015) Pembrolizumab versus ipilimumab in advanced melanoma. N Engl J Med 372(26):2521–2532. https://doi.org/10.1056/NEJMoa1503093

    Article  CAS  PubMed  Google Scholar 

  21. Hamid O, Robert C, Daud A et al (2019) Five-year survival outcomes for patients with advanced melanoma treated with pembrolizumab in KEYNOTE-001. Ann Oncol 30(4):582–588. https://doi.org/10.1093/annonc/mdz011

    Article  CAS  PubMed  PubMed Central  Google Scholar 

Download references

Funding

The authors declare that no funds, grants, or other supports were received during the preparation of this manuscript.

Author information

Authors and Affiliations

  1. Baylor College of Medicine, Houston, TX, USA

    Jonathan Lo & Hannah L. Hanania

  2. University of Texas McGovern Medical School, Houston, TX, USA

    Monika F. Keiser

  3. Department of Dermatology, University of Texas MD Anderson Cancer Center, Houston, TX, USA

    Anisha B. Patel

Authors
  1. Jonathan Lo
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Hannah L. Hanania
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Monika F. Keiser
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Anisha B. Patel
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

AP conceived the project. JL conducted the chart review, wrote initial drafts, and continued to edit and revise the manuscript until submission. HH and MK assisted in the chart review, manuscript writing and editing process. AP directly supervised the first three authors and worked closely with them on this manuscript in multiple aspects, including verification of chart review data and editing the manuscript.

Corresponding author

Correspondence to Anisha B. Patel.

Ethics declarations

Competing interests

The authors declare no competing interests.

Conflict of interest

The authors have no relevant financial or non-financial interests to disclose.

Ethics approval

This study was conducted under protocol PA15-0959, approved by our institutional IRB.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Lo, J., Hanania, H.L., Keiser, M.F. et al. Immune checkpoint inhibitor-induced vitiligo in cancer patients: characterization and management. Arch Dermatol Res 315, 1697–1703 (2023). https://doi.org/10.1007/s00403-023-02577-7

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00403-023-02577-7

Keywords

Search

Navigation