Lolli Cristian, Medri Matelda, Ricci Michela, Schepisi Giuseppe, Filograna Alessia, De Giorgi Ugo, Stanganelli Ignazio
Oncology Unit.
Skin Cancer Unit, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST), IRCCS, Meldola.
Medicine (Baltimore). 2018 Dec;97(52):e13810. doi: 10.1097/MD.0000000000013810.
The introduction of immune check-point inhibitors (ICIs) in the treatment of solid neoplasms is associated with the need to know and manage a new type of side effects that are commonly defined immune-mediated adverse events. Dermatologic immune-mediated adverse events are relatively common. Vitiligo-like lesions, defined as hypopigmented skin lesions, have already been associated with the use of ICIs in particular in patients with malignant melanoma, probably due to a common autoimmune mechanism against both melanoma cells and normal melanocytes. The onset of vitiligo-like lesions is very rare in non-melanoma patients and nowadays only few cases are described in the literature.
We described the case of a heavily pre-treated woman affected by renal cell carcinoma that has been treated with nivolumab for 2 years obtaining a stabilization of disease after an initial mild progression. After 9 months from the beginning of nivolumab, when the disease has reached its maximum stabilization, the patient developed vitiligo-like lesions of the back win halo nevi.
Vitiligo like lesion of the back not pre-existing before nivolumab treatment. The etiology was assumed to be nivolumab related as a result of an autoimmune activation against normal melanocytes.
The patient was followed with dermatological evaluations without changes in nivolumab dose and schedule OUTCOMES:: No variations of the described lesions were recorded after the first description. The patients underwent a durable stabilization of her tumor.
This case on the one hand is the first case of vitiligo-like lesions associated with ICIs in patients affected by renal cell carcinoma, and on the other hand it seems to confirm that the onset of immumomediate adverse reactions, but in particular vitiligo lesions, can probably be considered a sign of response to immunological treatments probably as a consequence of activation of the immune response.
在实体瘤治疗中引入免疫检查点抑制剂（ICI），需要了解和处理一类新的副作用，这类副作用通常被定义为免疫介导的不良事件。皮肤免疫介导的不良事件相对常见。白癜风样病变，即皮肤色素减退性病变，已被证实与ICI的使用有关，尤其是在恶性黑色素瘤患者中，这可能是由于针对黑色素瘤细胞和正常黑素细胞的共同自身免疫机制。在非黑色素瘤患者中，白癜风样病变的发生非常罕见，目前文献中仅有少数病例报道。
我们描述了一名接受过大量前期治疗的肾细胞癌女性患者的病例。她接受纳武单抗治疗2年，最初病情轻度进展后病情稳定。在开始使用纳武单抗9个月后，当病情达到最大稳定状态时，患者背部出现了伴有晕痣的白癜风样病变。
纳武单抗治疗前不存在的背部白癜风样病变。病因被认为与纳武单抗有关，是针对正常黑素细胞的自身免疫激活所致。
对患者进行皮肤科评估随访，纳武单抗剂量和给药方案不变。
首次描述后，所述病变无变化。患者肿瘤病情持续稳定。
一方面，该病例是肾细胞癌患者中首例与ICI相关的白癜风样病变；另一方面，似乎证实了免疫介导的不良反应，尤其是白癜风病变的出现，可能被视为免疫治疗反应的一个标志，这可能是免疫反应激活的结果。
