Vitiligo From Checkpoint Inhibitors Not Limited to Melanoma

The study covered in this summary was published on researchsquare.com as a preprint and has not yet been peer reviewed.

Key Takeaway

Vitiligo induced by immune checkpoint inhibitors (ICIs) can occur in virtually any type of cancer.

Why This Matters

The finding challenges the notion that ICI-induced vitiligo is limited to melanoma patients.
With growing use of checkpoint inhibitors for nonmelanoma cancers, the diversity of patients’ skin color is expected to increase, leading to a greater impact of vitiligo on quality of life and importance of vitiligo-related outcomes.

Study Design

The study team reviewed 151 patients with ICI-induced vitiligo at their institution.
Patients were treated primarily with pembrolizumab, nivolumab, and ipilimumab, either alone or in combination.

Key Results

Of patients with ICI-induced vitiligo, the majority had melanoma (77.4%); 19 (12.6%) had other types of cancer.
The nonmelanoma group included patients with non–small cell lung cancer (n = 6), renal cell carcinoma (n = 5), breast cancer (n = 2), cutaneous squamous cell carcinoma (n = 2), angiosarcoma (n = 1), Hodgkin lymphoma (n =1), small cell lung cancer (n = 1), and mycosis fungoides (n = 1).
In the melanoma group, the median time to vitiligo onset was 209 days, compared to 382 days in the nonmelanoma group. The investigators suggest that patients in the nonmelanoma group may not have undergone regular skin exams and thus their diagnoses were delayed.
The majority of patients had a stable course of vitiligo, with 91.4% in the largely White cohort receiving no treatment.
Two Black patients with nonmelanoma cancers had a nearly complete response to narrowband ultraviolet B light therapy and topical steroids.

Limitations

Vitiligo reporting was often inconsistent, with skipped chart notes and nonspecific descriptions.
It’s unknown if vitiligo is associated with good outcomes in cancers other than melanoma.

Disclosures

There was no funding for the study, and the investigators disclosed no relevant financial relationships.

This is a summary of a preprint research study, “Immune Checkpoint Inhibitor Induced Vitiligo in Non-Melanoma Patients: Characterization and Management,” led by Jonathan Lo of the Baylor College of Medicine, Houston. The study has not been peer reviewed. The full text can be found at researchsquare.com.

M. Alexander Otto is a physician assistant with a master’s degree in medical science and a journalism degree from Newhouse. He is an award-winning medical journalist who has worked for several major news outlets before joining Medscape and also an MIT Knight Science Journalism fellow. Email: [email protected]. Email: [email protected].

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