Rao Hui, Guo Zheng, Wen Xuejiao, Zeng Xiaoli, Wu Longqiu, Huang Li
The First Clinical Medical College, Gannan Medical University, Ganzhou, Jiangxi, China.
Department of Hematology and Oncology, International Cancer Center, Shenzhen University General Hospital, Shenzhen University Clinical Medical Academy, Shenzhen, Guangdong, China.
Front Oncol. 2023 Jan 13;12:1099108. doi: 10.3389/fonc.2022.1099108. eCollection 2022.
Vitiligo-like depigmentation is a common skin adverse event in patients receiving immunotherapy for malignant melanoma, but has been rarely reported in patients with non-melanoma malignancies. To better understand this immune-related adverse event, we reviewed a series of cases of immunotherapy induced vitiligo-like depigmentation in patients with cancers other than malignant melanoma.
We report three cases of vitiligo-like depigmentation after immune checkpoint inhibitor treatment in gastric adenocarcinoma, lung adenocarcinoma, and squamous cell carcinoma. The first case was treated with camrelizumab, the second was treated with QL1706 injection and sintilimab, and the third was treated with tislelizumab. Pembrolizumab, nivolumab, and ipilimumab caused the majority of vitiligo-like depigmentation, and all three of our patients experienced similar vitiligo-like depigmentation after taking other immune checkpoint inhibitors.
Three patients who presented with vitiligo-like depigmentation after treatment with immune checkpoint inhibitors were selected. The clinical features, including radiological and histological examination, and the treatment process were reviewed. Eighteen previously published cases of vitiligo-like depigmentation were also used to analyze the results. The severity of vitiligo-like depigmentation in these cases was graded according to the Common Terminology Criteria for Adverse Events, version 5.0.
Vitiligo-like depigmentation occurred in 13 men (61.90%) and 8 women (38.10%), aged from 46 to 79 years, with an average age of 69.9 years. Of the 21 reviewed cases, vitiligo-like depigmentation was described in lung cancer (13/21, 61.90%), clear cell renal cell carcinoma (2/21, 9.52%), acute myeloid leukemia (1/21, 4.76%), cholangiocarcinoma (1/21, 4.76%), urothelial carcinoma (1/21, 4.76%), oral squamous cell carcinoma (1/21, 4.76%), esophageal squamous cell carcinoma (1/21, 4.76%), and gastric adenocarcinoma (1/21, 4.76%). The severity of vitiligo-like depigmentation after immunotherapy was unrelated to sex, age, cancer type, previous autoimmune diseases, and medication.
Vitiligo-like depigmentation is a non-specific skin adverse event in melanoma immunotherapy, but arises as a direct result of treatment with immune checkpoint inhibitors. Vitiligo-like depigmentation has an irregular location, is not limited to direct sunlight cracks, and has also been reported on hair on the head, eyelashes, and eyebrows. People without any skin or autoimmune diseases can also experience vitiligo-like depigmentation after immunotherapy; the incidence of which is irrespective of sex, age, cancer type, previous autoimmune diseases, and medication.
白癜风样色素脱失是接受恶性黑色素瘤免疫治疗患者中常见的皮肤不良事件，但在非黑色素瘤恶性肿瘤患者中鲜有报道。为更好地了解这种免疫相关不良事件，我们回顾了一系列非恶性黑色素瘤癌症患者免疫治疗诱发白癜风样色素脱失的病例。
我们报告了3例胃腺癌、肺腺癌和鳞状细胞癌患者在接受免疫检查点抑制剂治疗后出现白癜风样色素脱失的病例。第1例接受卡瑞利珠单抗治疗，第2例接受QL1706注射液和信迪利单抗治疗，第3例接受替雷利珠单抗治疗。帕博利珠单抗、纳武利尤单抗和伊匹木单抗导致了大多数白癜风样色素脱失，我们的3例患者在使用其他免疫检查点抑制剂后也出现了类似的白癜风样色素脱失。
选取3例接受免疫检查点抑制剂治疗后出现白癜风样色素脱失的患者。回顾其临床特征，包括影像学和组织学检查以及治疗过程。还使用了18例先前发表的白癜风样色素脱失病例来分析结果。根据不良事件通用术语标准第5.0版对这些病例中白癜风样色素脱失的严重程度进行分级。
白癜风样色素脱失发生在13名男性（61.90%）和8名女性（38.10%）中，年龄在46至79岁之间，平均年龄为69.9岁。在21例回顾病例中，肺癌（13/21，61.90%）、透明细胞肾细胞癌（2/21，9.52%）、急性髓系白血病（1/21，4.76%）、胆管癌（1/21，4.76%）、尿路上皮癌（1/21，4.76%）、口腔鳞状细胞癌（1/21，4.76%）、食管鳞状细胞癌（1/21，4.76%）和胃腺癌（]/21，4.76%）中均有白癜风样色素脱失的描述。免疫治疗后白癜风样色素脱失的严重程度与性别、年龄、癌症类型、既往自身免疫性疾病及用药无关。
白癜风样色素脱失是黑色素瘤免疫治疗中的一种非特异性皮肤不良事件，但却是免疫检查点抑制剂治疗的直接结果。白癜风样色素脱失部位不规则，不限于阳光直射部位，头皮毛发、睫毛和眉毛处也有报道。无任何皮肤或自身免疫性疾病的人在免疫治疗后也可能出现白癜风样色素脱失；其发生率与性别、年龄、癌症类型、既往自身免疫性疾病及用药无关。
