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Coelho JQ, Romão R, Sousa MJ, Azevedo SX, Fidalgo P, Araújo A. Vitiligo-like Lesions as a Predictor of Response to Immunotherapy in Non-Small Cell Lung Cancer: Comprehensive Review and Case Series from a University Center. Curr Oncol 2024; 31:1113-1128. [PMID: 38392077 PMCID: PMC10887781 DOI: 10.3390/curroncol31020083] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2024] [Revised: 01/31/2024] [Accepted: 02/12/2024] [Indexed: 02/24/2024] Open
Abstract
The reference to vitiligo-like lesions (VLLs) induced by immune checkpoint inhibitors (ICIs) as a valuable predictive marker of treatment success of immunotherapy with ICIs in melanoma has been mentioned in the literature. Its role in non-small cell lung cancer (NSCLC)-treated patients remains a poorly recognized phenomenon with uncertain significance regarding its predictive value. A retrospective, observational, single-center report was performed, with descriptive analysis of clinicopathological and treatment characteristics of patients with stage IV NSCLC who developed ICI-induced VLL between January 2018 and December 2022, contextualized in a comprehensive review of the literature and reported cases regarding this phenomenon. During the first 5 years' experience of ICI use in stage IV NSCLC treatment, three cases of ICI-induced VLLs were diagnosed. In line with the previous reports, two of the three presented cases exhibited treatment response and favorable prognosis. The recognition and understanding of the pathophysiological processes underlying ICI-induced VLLs may represent a promising opportunity to identify a predictive marker of tumor response to ICIs, with impact in treatment selection and patient management. It also may contribute to the recognition of new patterns of molecular expression that could lead to improvements in therapeutic development.
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Affiliation(s)
| | - Raquel Romão
- Unidade Local de Saúde de Santo António, 4099-001 Porto, Portugal
| | - Maria João Sousa
- Unidade Local de Saúde de Santo António, 4099-001 Porto, Portugal
| | | | - Paula Fidalgo
- Unidade Local de Saúde de Santo António, 4099-001 Porto, Portugal
| | - António Araújo
- Unidade Local de Saúde de Santo António, 4099-001 Porto, Portugal
- Oncology Research Unit, 4050-346 Porto, Portugal
- UMIB—Unit for Multidisciplinary Research in Biomedicine, 4050-346 Porto, Portugal
- ICBAS—School of Medicine and Biomedical Sciences, University of Porto, 4050-313 Porto, Portugal
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Carmona-Rocha E, Sullivan I, Yélamos O. Vitiligo-like hypopigmentation induced by dabrafenib-trametinib: a potential marker for clinical response. Melanoma Res 2023; 33:553-555. [PMID: 37890183 DOI: 10.1097/cmr.0000000000000918] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/29/2023]
Affiliation(s)
- Elena Carmona-Rocha
- Dermatology Department, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona
- Institut d'Investigació Biomèdica Sant Pau (IIB SANT PAU)
| | - Ivana Sullivan
- Institut d'Investigació Biomèdica Sant Pau (IIB SANT PAU)
- Oncoloy Department, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Oriol Yélamos
- Dermatology Department, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona
- Institut d'Investigació Biomèdica Sant Pau (IIB SANT PAU)
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Saray S, Hızlı P. Case report: Drug-induced vitiligo during treatment with BRAF/MEK inhibitors in a patient with metastatic conjunctival melanoma. J Oncol Pharm Pract 2023:10781552231189819. [PMID: 37499639 DOI: 10.1177/10781552231189819] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/29/2023]
Abstract
INTRODUCTION Autoimmune side effects can be detected during the use of BRAF/MEK inhibitor. Although its frequency, mechanism and importance are not known exactly, there are cases reported in the literature. CASE REPORT We report a case of drug-induced vitiligo in a patient with metastatic conjunctival malignant melanoma who was treated with BRAF/MEK inhibition therapy. MANAGEMENT AND OUTCOME In the case, vitiligo was controlled with topical treatments. Follow-up process of the patient has been continuing with no progression on month 12 of the current treatment. DISCUSSION Although ICI-related autoimmune side effects and vitiligo have been described more frequently, vitiligo may also occur secondary to BRAK/MEK inhibition. This case also points out that cutaneous toxicity is manageable with no delay in treatment thanks to collaboration of dermatologists and oncologists.
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Affiliation(s)
- Seray Saray
- Department of Medical Oncology, Balıkesir Ataturk State Hospital, Balıkesir, Turkey
| | - Pelin Hızlı
- Department of Dermatology, Faculty of Medicine, Balikesir University, Balikesir, Turkey
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4
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Venetoclax-induced vitiligo in a patient with chronic lymphocytic leukemia. Anticancer Drugs 2022; 33:1167-1170. [DOI: 10.1097/cad.0000000000001350] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Clinical Presentation and Prognostic Features in Patients with Immunotherapy-Induced Vitiligo-like Depigmentation: A Monocentric Prospective Observational Study. Cancers (Basel) 2022; 14:cancers14194576. [PMID: 36230498 PMCID: PMC9558529 DOI: 10.3390/cancers14194576] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2022] [Revised: 09/08/2022] [Accepted: 09/15/2022] [Indexed: 11/16/2022] Open
Abstract
Vitiligo-like depigmentation (VLD) is an immune-related adverse event (irAE) of checkpoint-inhibitor (CPI) treatment, which has previously been associated with a favourable outcome. The aim of this study was to explore clinical, biological and prognostic features of melanoma patients with VLD under CPI-treatment and to explore whether they exhibit a characteristic immune response profile in peripheral blood. Melanoma patients developing VLD under CPI were included in a prospective observational single-center cohort study. We collected and analysed clinical parameters, photographs and serum from 28 VLD patients. They received pembrolizumab (36%), nivolumab (11%), ipilimumab/nivolumab (32%) or clinical trial medications (21%). We performed a high-throughput proteomics assay (Olink), in which we identified a distinct proteomic signature in VLD patients in comparison to non-VLD CPI patients. Our clinical assessments revealed that VLD lesions had a predominantly symmetrical distribution pattern, with mostly smaller “freckle-like” macules and a preferential distribution in UV-exposed areas. Patients with previous targeted therapy showed a significantly longer time lapse between CPI initiation and VLD onset compared to non-pre-treated patients (12.5 vs. 6.25 months). Therapy responders exhibited a distinct proteomic profile when compared with non-responders in VLD such as upregulation of EDAR and downregulation of LAG3. ITGA11 was elevated in the VLD-group when compared to non-VLD-CPI-treated melanoma patients. Our findings demonstrate that on a proteomic level, VLD is characterized by a distinct immune signature when compared to CPI-treated patients without VLD and that therapy responsiveness is reflected by a characteristic immune profile. The pathomechanisms underlying these findings and how they could relate to the antitumoral response in melanoma remain to be elucidated.
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6
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Carbamazepine-induced reversible vitiligo. JAAD Case Rep 2022; 26:3-5. [PMID: 35815232 PMCID: PMC9256838 DOI: 10.1016/j.jdcr.2022.05.042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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Cavallo F, Roccuzzo G, Avallone G, Conforti C, Zalaudek I, Giordano S, Rubatto M, Fava P, Ribero S, Quaglino P. Extensive "halo naevi" phenomenon and regression of melanin during nivolumab treatment in metastatic melanoma: a predictor of a better outcome? Dermatol Ther 2022; 35:e15559. [PMID: 35524707 DOI: 10.1111/dth.15559] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2022] [Revised: 04/10/2022] [Accepted: 05/04/2022] [Indexed: 12/01/2022]
Affiliation(s)
- Francesco Cavallo
- Section of Dermatology, Department of Medical Sciences, University of Turin, Turin, Italy
| | - Gabriele Roccuzzo
- Section of Dermatology, Department of Medical Sciences, University of Turin, Turin, Italy
| | - Gianluca Avallone
- Section of Dermatology, Department of Medical Sciences, University of Turin, Turin, Italy
| | | | - Iris Zalaudek
- Dermatology Clinic, Maggiore Hospital, University of Trieste
| | - Silvia Giordano
- Section of Dermatology, Department of Medical Sciences, University of Turin, Turin, Italy
| | - Marco Rubatto
- Section of Dermatology, Department of Medical Sciences, University of Turin, Turin, Italy
| | - Paolo Fava
- Section of Dermatology, Department of Medical Sciences, University of Turin, Turin, Italy
| | - Simone Ribero
- Section of Dermatology, Department of Medical Sciences, University of Turin, Turin, Italy
| | - Pietro Quaglino
- Section of Dermatology, Department of Medical Sciences, University of Turin, Turin, Italy
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Dousset L, Pacaud A, Barnetche T, Kostine M, Dutriaux C, Pham-Ledard A, Beylot-Barry M, Gérard E, Prey S, Andreu N, Boniface K, Seneschal J. Analysis of tumor response and clinical factors associated with vitiligo in patients receiving anti-programmed cell death-1 therapies for melanoma: A cross-sectional study. JAAD Int 2021; 5:112-120. [PMID: 34712997 PMCID: PMC8529074 DOI: 10.1016/j.jdin.2021.09.002] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/10/2021] [Indexed: 12/18/2022] Open
Abstract
Background Clinical factors associated with vitiligo in patients receiving anti–programmed cell death-1 (PD-1) remain unknown. Objective To better characterize the occurrence of vitiligo in patients receiving anti–PD-1. Methods The present single-center ambispective cohort study included patients with melanoma treated with anti–PD-1. Progression-free survival, overall survival, and objective tumor response were compared between patients with and those without vitiligo using Kaplan-Meier curves and the log-rank test. Demographic and clinical factors associated with vitiligo were evaluated using multivariate logistic regression. Results Of the 457 patients included in the study, vitiligo developed in 85 patients. The clinical presentation of vitiligo consisted of the presence of ovalar and multiple flecked white macules, mainly located on chronic sun-exposed areas. The presence of vitiligo was associated with a significant improvement in overall survival and progression-free survival (P < .001). A Cox proportional hazards model estimation demonstrated markedly improved survival in patients with vitiligo compared with those without vitiligo (aHR [overall survival], 0.20; 95% CI, 0.12-0.33; P < .001; and aHR [progression-free survival], 0.33; 95% CI, 0.23-0.47; P < .001). In the multivariate logistic regression analyses, men showed an independent increased risk of the development of vitiligo (odds ratio, 1.66). In contrast, the presence of pulmonary metastases was found to be an independent factor associated with a reduced risk of the development of vitiligo (odds ratio, 0.50). Limitations Single-center ambispective cohort. Conclusion Vitiligo in patients receiving anti–PD-1 for advanced melanoma is associated with a better outcome. A gender effect associated with the development of vitiligo will need further investigation.
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Affiliation(s)
- Léa Dousset
- Department of Dermatology, National Centre for Rare Skin Disorders, University Hospital of Bordeaux, Bordeaux, France
| | - Alize Pacaud
- Department of Dermatology, National Centre for Rare Skin Disorders, University Hospital of Bordeaux, Bordeaux, France
| | - Thomas Barnetche
- Department of Rheumatology, National Reference Center for Severe Systemic Autoimmune Diseases, FHU ACRONIM, Pellegrin Hospital, University Hospital of Bordeaux, Bordeaux, France
| | - Marie Kostine
- Department of Rheumatology, National Reference Center for Severe Systemic Autoimmune Diseases, FHU ACRONIM, Pellegrin Hospital, University Hospital of Bordeaux, Bordeaux, France
| | - Caroline Dutriaux
- Department of Dermatology, National Centre for Rare Skin Disorders, University Hospital of Bordeaux, Bordeaux, France.,U1035 INSERM, Biotherapy of Genetic Diseases, Inflammatory Disorders and Cancers, Bordeaux University, Bordeaux, France
| | - Anne Pham-Ledard
- Department of Dermatology, National Centre for Rare Skin Disorders, University Hospital of Bordeaux, Bordeaux, France
| | - Marie Beylot-Barry
- Department of Dermatology, National Centre for Rare Skin Disorders, University Hospital of Bordeaux, Bordeaux, France
| | - Emilie Gérard
- Department of Dermatology, National Centre for Rare Skin Disorders, University Hospital of Bordeaux, Bordeaux, France
| | - Sorilla Prey
- Department of Dermatology, National Centre for Rare Skin Disorders, University Hospital of Bordeaux, Bordeaux, France.,U1035 INSERM, Biotherapy of Genetic Diseases, Inflammatory Disorders and Cancers, Bordeaux University, Bordeaux, France
| | - Nicolas Andreu
- Department of Dermatology, National Centre for Rare Skin Disorders, University Hospital of Bordeaux, Bordeaux, France
| | - Katia Boniface
- U1035 INSERM, Biotherapy of Genetic Diseases, Inflammatory Disorders and Cancers, Bordeaux University, Bordeaux, France
| | - Julien Seneschal
- Department of Dermatology, National Centre for Rare Skin Disorders, University Hospital of Bordeaux, Bordeaux, France.,U1035 INSERM, Biotherapy of Genetic Diseases, Inflammatory Disorders and Cancers, Bordeaux University, Bordeaux, France
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9
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Burzi L, Alessandrini AM, Quaglino P, Piraccini BM, Dika E, Ribero S. Cutaneous Events Associated with Immunotherapy of Melanoma: A Review. J Clin Med 2021; 10:jcm10143047. [PMID: 34300213 PMCID: PMC8308045 DOI: 10.3390/jcm10143047] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2021] [Revised: 06/17/2021] [Accepted: 07/06/2021] [Indexed: 02/07/2023] Open
Abstract
Immunotherapy with checkpoint inhibitors significantly improves the outcome for stage III and IV melanoma. Cutaneous adverse events during treatment are often reported. We herein aim to review the principal pigmentation changes induced by immune check-point inhibitors: the appearance of vitiligo, the Sutton phenomenon, melanosis and hair and nail toxicities.
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Affiliation(s)
- Lorenza Burzi
- Department of Medical Sciences, Dermatology Clinic, University of Turin, 10126 Turin, Italy; (L.B.); (P.Q.)
| | - Aurora Maria Alessandrini
- Dermatology, Department of Experimental Diagnostic and Specialty Medicine (DIMES), University of Bologna, 40138 Bologna, Italy; (A.M.A.); (B.M.P.); (E.D.)
- Dermatology, IRCCS Sant’Orsola Hospital, 40138 Bologna, Italy
| | - Pietro Quaglino
- Department of Medical Sciences, Dermatology Clinic, University of Turin, 10126 Turin, Italy; (L.B.); (P.Q.)
| | - Bianca Maria Piraccini
- Dermatology, Department of Experimental Diagnostic and Specialty Medicine (DIMES), University of Bologna, 40138 Bologna, Italy; (A.M.A.); (B.M.P.); (E.D.)
- Dermatology, IRCCS Sant’Orsola Hospital, 40138 Bologna, Italy
| | - Emi Dika
- Dermatology, Department of Experimental Diagnostic and Specialty Medicine (DIMES), University of Bologna, 40138 Bologna, Italy; (A.M.A.); (B.M.P.); (E.D.)
- Dermatology, IRCCS Sant’Orsola Hospital, 40138 Bologna, Italy
| | - Simone Ribero
- Department of Medical Sciences, Dermatology Clinic, University of Turin, 10126 Turin, Italy; (L.B.); (P.Q.)
- Correspondence:
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10
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Lommerts JE, Bekkenk MW, Luiten RM. Vitiligo induced by immune checkpoint inhibitors in melanoma patients: an expert opinion. Expert Opin Drug Saf 2021; 20:883-888. [PMID: 33896329 DOI: 10.1080/14740338.2021.1915279] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Introduction: Treatment with immune checkpoint inhibitors in melanoma patients can cause immune-related adverse effects, such as vitiligo. In vitiligo, specific autoimmunity against melanocytes results in depigmentation of the skin. Melanoma-associated vitiligo occurring in melanoma patients treated with immune checkpoint inhibitors can be seen as a good prognostic sign as higher survival rates in melanoma-associated vitiligo cases have been reported.Areas covered: This review gives an insight into the pathophysiology, clinical presentation, and management of melanoma-associated vitiligo caused by immune checkpoint inhibitors.Expert opinion: Development of melanoma-associated vitiligo induced by immune checkpoint inhibitors could be a good clinical marker for response and overall survival. Induction of vitiligo in these patients could also potentially lead to better response and survival rates. Further research should focus on several aspects of melanoma-associated vitiligo, such as better screening and registration, more understanding of pathophysiology of the type of immune response and the predictive value of melanoma-associated in patients treated with immune checkpoint inhibitors.
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Affiliation(s)
- Janny E Lommerts
- Department of Dermatology and Netherlands Institute for Pigment Disorders, Amsterdam University Medical Centers, University of Amsterdam, Cancer Center Amsterdam, Amsterdam Institute for Infection and Immunity, Amsterdam, The Netherlands
| | - Marcel W Bekkenk
- Department of Dermatology and Netherlands Institute for Pigment Disorders, Amsterdam University Medical Centers, University of Amsterdam, Cancer Center Amsterdam, Amsterdam Institute for Infection and Immunity, Amsterdam, The Netherlands
| | - Rosalie M Luiten
- Department of Dermatology and Netherlands Institute for Pigment Disorders, Amsterdam University Medical Centers, University of Amsterdam, Cancer Center Amsterdam, Amsterdam Institute for Infection and Immunity, Amsterdam, The Netherlands
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11
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Vitiligo and Melanoma-Associated Vitiligo: Understanding Their Similarities and Differences. Am J Clin Dermatol 2020; 21:669-680. [PMID: 32468356 DOI: 10.1007/s40257-020-00524-0] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND There has been a significant increase in the number and efficacy of therapies for advanced melanoma. Immunotherapies, such as anti-cytotoxic T-lymphocyte antigen-4 and programmed cell death-1 inhibitors, have improved the prognosis for patients with advanced melanoma. While spontaneous melanoma-associated vitiligo is a known phenomenon, the occurrence of melanoma-associated vitiligo following melanoma therapy is now recognized to associate with favorable outcomes. OBJECTIVE The objective of this article is to provide a comprehensive literature review of melanoma-associated vitiligo and explore the insights these findings provide about the pathobiology of vitiligo and mechanisms underlying melanoma therapies. METHODS PubMed and Science Direct databases were searched for studies pertaining to melanoma-associated vitiligo. The 36 studies reviewed included meta-analyses (n = 2), prospective cohort studies (n = 4), prospective observational studies (n = 3), retrospective studies (n = 12), case series (n = 2), and case reports (n = 13). RESULTS The basic mechanisms underlying melanoma-associated vitiligo and vitiligo may be shared. Characterization of these mechanisms will identify new biomarkers and therapeutic targets for both melanoma and vitiligo. CONCLUSIONS Co-opting the immune system to target tumor antigens highlights the potential overlap between anti-tumor immunity and autoimmunity. The development of vitiligo-like depigmentation in association with immunotherapy for melanoma may provide insights into both the immune response against melanoma as well as the pathogenesis of vitiligo.
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12
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Torres‐Navarro I, de Unamuno‐Bustos B, Botella‐Estrada R. Systematic review of BRAF/MEK inhibitors‐induced Severe Cutaneous Adverse Reactions (SCARs). J Eur Acad Dermatol Venereol 2020; 35:607-614. [DOI: 10.1111/jdv.16894] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2020] [Revised: 07/22/2020] [Accepted: 07/29/2020] [Indexed: 12/13/2022]
Affiliation(s)
- I. Torres‐Navarro
- Dermatology Department Hospital Universitario y Politécnico la Fe València Spain
| | - B. de Unamuno‐Bustos
- Dermatology Department Hospital Universitario y Politécnico la Fe València Spain
| | - R. Botella‐Estrada
- Dermatology Department Hospital Universitario y Politécnico la Fe València Spain
- Department of Medicine Universitat de València València Spain
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13
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Rovers JFJ, Bovenschen HJ. Dermatological side effects rarely interfere with the continuation of checkpoint inhibitor immunotherapy for cancer. Int J Dermatol 2020; 59:1485-1490. [PMID: 32895923 DOI: 10.1111/ijd.15163] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2020] [Revised: 05/30/2020] [Accepted: 08/06/2020] [Indexed: 11/28/2022]
Abstract
BACKGROUND Immunotherapy with checkpoint inhibitors (CPIs) is an emerging anticancer treatment strategy, which may cause a variety of skin reactions. In this study, we sought to analyze and classify the cutaneous side effects (CSE) of the CPIs nivolumab, pembrolizumab, and ipilimumab with respect to prevalence, type, and severity, and to review their potential interference with CPI immunotherapy. METHODS In this retrospective analysis, medical records were analyzed with respect to incidence, type, and severity of CSE in patients on CPI immunotherapy for cancer. The implications for immunotherapy maintenance were scrutinized. RESULTS From 2012 to 2019, 352 consecutive patients were treated with CPIs for cancer, of which 46 patients (13.1%) experienced CSE. The incidence of CSE was less with nivolumab (n = 16; 9.5%) and pembrolizumab monotherapy (n = 9; 9.6%) as compared to ipilimumab (n = 10; 23.3%) and combination therapy (n = 11; 23.9%); P < 0.05. Skin toxicity could be stratified by rash/eczema (n = 28; 60.9%), autoimmune (n = 8; 17.4%, vitiligo n = 5, lichen sclerosus n = 2, psoriasis guttata n = 1), lichenoid reaction (n = 5; 10.9%), pruritus (n = 4; 8.7%), and a miscellaneous group (n = 3; 6.5%). The limited severity grades of CSE caused immunotherapy disruption in only three (0.9%) cases. Interestingly, 80% of melanoma patients who developed vitiligo during immunotherapy had stable disease or disease remission. CONCLUSION CPIs in cancer patients may result in a distinct set of CSE, with drug rash and eczematous rash being the most common. CTLA-4 blocker ipilimumab and combination therapy are more prone to elicit skin toxicity than the PD-1 inhibitors nivolumab and pembrolizumab, although this rarely interferes with the continuation of immunotherapy.
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Affiliation(s)
- Jessica F J Rovers
- Department of Dermatology, Máxima Medical Center Veldhoven, Veldhoven, The Netherlands
| | - H Jorn Bovenschen
- Department of Dermatology, Máxima Medical Center Veldhoven, Veldhoven, The Netherlands
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14
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Histological regression in primary melanoma and drug-related immune reaction towards metastatic melanoma: Are they associated?? Med Hypotheses 2020; 143:110019. [PMID: 32645656 DOI: 10.1016/j.mehy.2020.110019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2020] [Accepted: 06/17/2020] [Indexed: 11/21/2022]
Abstract
Histologic regression has recently been associated with a more favorable prognosis in primary melanoma. historically this immune phenomenon was described as a negative prognostic factor able to substage the true Breslow thickness. Since many years we have assisted to the appearance of vitiligo in metastatic melanoma patients. This has been considered one of the explanations of the immunogenicity of this disease, as inducing a strong immune reaction against cancer cells able to kill normal melanocytes even far from the metastatic lesions, This vitiligo like reaction has been seen even stronger in patients treated with immune and target therapy. The three phenomena involve the same pattern of lymphocytes. The association between the three can explain the better prognosis of the patients with primary melanoma with histological regression as well as the longer survival of the vitiligo like immune reaction in metastatic melanoma patients.
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15
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Anthony N, Bourneau-Martin D, Ghamrawi S, Lagarce L, Babin M, Briet M. Drug-induced vitiligo: a case/non-case study in Vigibase ® , the WHO pharmacovigilance database. Fundam Clin Pharmacol 2020; 34:736-742. [PMID: 32246859 DOI: 10.1111/fcp.12558] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2019] [Revised: 03/26/2020] [Accepted: 03/29/2020] [Indexed: 02/06/2023]
Abstract
Vitiligo is a common depigmenting disorder ensuing the loss of epidermal melanocytes. It is a multifactorial disease with immunological, genetic and environmental factors including drug exposure. The purpose of the study was to investigate the drugs and therapeutic subclasses associated with vitiligo occurrence reported in VigiBase® , the WHO pharmacovigilance database. A case/non-case study was carried out by defining cases as vitiligo reports and non-cases as all other reports. The reporting odds ratio (ROR) was calculated for the 'suspected' drugs and drug classes according to ATC level 4. During the study period, 741 cases of vitiligo were registered. Mean age was 49 ± 20 years. The disproportionality analysis showed an association between vitiligo and pembrolizumab (ROR 116.9, 95% Confidence Interval (CI) 94.8, 144.3), nivolumab (ROR 22.6, 95% CI 15.8, 32.4), ipilimumab (ROR 41.7, 95% CI 25.0, 69.7), imiquimod (ROR 152.8, 95% CI 103.0, 226.7), adalimumab (ROR 3.8, 95% CI 2.5,5.8), infliximab (ROR 2.6, 95% CI 1.65, 4.01), alemtuzumab (ROR 27.8, 95% CI 17.6, 43.9), and ustekinumab (ROR 9.3, 95% CI 5.6, 15.6). Concerning the pharmacological classes ATC level 4, a significant association was found with monoclonal antibodies, interferons, selective immunosuppressants, TNF-alpha inhibitors, interleukin inhibitors, and topical antivirals. This study confirmed the expected associations between vitiligo and immune checkpoint inhibitors and strengthened the emerging signal about the association between vitiligo and imiquimod, TNF-alpha inhibitors and interferons. New signals were shown with selective immunosuppressants including alemtuzumab and interleukin inhibitors.
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Affiliation(s)
- Norah Anthony
- Service de Pharmacologie-Toxicologie et Pharmacovigilance, Centre hospitalo-Universitaire d'Angers, 4 rue larrey, 49100, Angers, France
| | - Delphine Bourneau-Martin
- Service de Pharmacologie-Toxicologie et Pharmacovigilance, Centre hospitalo-Universitaire d'Angers, 4 rue larrey, 49100, Angers, France
| | - Sarah Ghamrawi
- Service de Pharmacologie-Toxicologie et Pharmacovigilance, Centre hospitalo-Universitaire d'Angers, 4 rue larrey, 49100, Angers, France
| | - Laurence Lagarce
- Service de Pharmacologie-Toxicologie et Pharmacovigilance, Centre hospitalo-Universitaire d'Angers, 4 rue larrey, 49100, Angers, France
| | - Marina Babin
- Service de Pharmacologie-Toxicologie et Pharmacovigilance, Centre hospitalo-Universitaire d'Angers, 4 rue larrey, 49100, Angers, France
| | - Marie Briet
- Service de Pharmacologie-Toxicologie et Pharmacovigilance, Centre hospitalo-Universitaire d'Angers, 4 rue larrey, 49100, Angers, France.,Université d'Angers, Angers, France.,Laboratoire MitoVasc, UMR CNRS 6214 INSERM 1083, Angers, France
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