Clinical and Pathological Relevance of Drug-induced Vitiligo in Patients Treated for Metastatic Melanoma with Anti-PD1 or BRAF/MEK Inhibitors
Alice Ramondetta, Simone Ribero, Luca Conti, Paolo Fava, Elena Marra, Paolo Broganelli, Virginia Caliendo, Franco Picciotto, Michele Guida, Maria Teresa Fierro, Pietro Quaglino
Current therapies for metastatic melanoma (anti-PD1 and BRAF/MEK inhibitors) can cause drug-induced vitiligo. The aim of this study is to dermatologically define and histologically characterize this new type of vitiligo, and assess the clinical course of the disease. Fourteen patients with metastatic melanoma treated with immune or targeted therapy were included in a dataset evaluating clinical data, vitiligo description and histopathological features. Vitiligo-like lesions occurred after a mean of 7.5 months from the start of the therapies (range 1–42 months), with a prevalence of the non-segmental variant (71.4%). Fifty percent of patients showed a clinical response (4 complete response and 3 partial response), 35.7% had stable disease, and one patient died after disease progression. Median survival from the start of the therapies was 32.5 months. Drug-induced vitiligo can be related to both immune and targeted therapies, is associated with a favourable prognosis, and has clinical characteristics different from the classical form.
There is a new type of vitiligo called “drug-induced” because it appears in some patients treated for metastatic melanoma with immune and targeted therapy. This study analysed this phenomenon from a clinical, prognostic and histopathological aspects. This is the first study to classify drug-induced vitiligo according to the European Guidelines for the management of vitiligo, revealing that the most frequent subtype is the non-segmental form (71.4%). Moreover, the study showed that vitiligo can also develop in patients treated with targeted therapies, and the patients who develop vitiligo had a favorable prognosis, with a median overall survival of 57 months.