Pozuelo-Ruiz Mónica, de Unamuno-Bustos Blanca, Palacios-Diaz Rodolfo D, Blanes-Martínez María Del Mar, Juan-Carpena Gloria, Martínez-Banaclocha Natividad, Botella-Estrada Rafael
Department of Dermatology, Hospital Universitario y Politécnico La Fe.
Dermatology and Tisular Regeneration Group, Health Research Institute La Fe, Valencia.
Melanoma Res. 2025 Apr 1;35(2):148-152. doi: 10.1097/CMR.0000000000001018. Epub 2025 Jan 7.
Vitiligo-like hypopigmentation induced by immune checkpoint inhibitors (ICIs) has been largely associated with improved survival outcomes in metastatic melanoma. However, its development during adjuvant ICI therapy and its role as a prognostic factor in this setting remain unclear. We aimed to describe ICI-induced vitiligo in a cohort of patients with resected stage III melanoma treated with adjuvant ICI and to identify differences in progression-free survival (PFS) and distant metastasis-free survival (DMFS) between those who developed vitiligo and those who did not. Patients and data were collected from two institutions, both retrospectively and prospectively, from January 2018 to February 2024. Patients were divided into 'vitiligo' and 'non-vitiligo' groups for comparisons. Of 40 patients, 22.5% developed ICI-induced vitiligo [median follow-up: 23 months (1-73)]. Treatments received were nivolumab (70%) and pembrolizumab (30%). Fifty-five percent of the patients completed 1 year of treatment, 37.5% discontinued and 7.5% were still ongoing. Vitiligo and non-vitiligo groups differed in the cause of treatment discontinuation (severe toxicity in vitiligo vs. progression in non-vitiligo, P = 0.005) and the occurrence of progression (none in vitiligo vs. 52% in non-vitiligo, P = 0.001). Survival analyses showed longer PFS in vitiligo group ( P = 0.013) and no differences in DMFS ( P = 0.111). ICI-induced vitiligo typically affected photo-exposed areas, with a median time to onset of 4 months (1-27). These preliminary results on ICI-induced vitiligo in adjuvant treatment are in agreement with those reported in advanced melanoma treatment, so its development in the adjuvant setting could be a sign of good prognosis as well.
免疫检查点抑制剂（ICI）诱导的白癜风样色素减退在很大程度上与转移性黑色素瘤患者生存率的提高相关。然而，其在辅助ICI治疗期间的发生情况及其在这种情况下作为预后因素的作用仍不清楚。我们旨在描述接受辅助ICI治疗的III期黑色素瘤切除患者队列中ICI诱导的白癜风情况，并确定发生白癜风的患者与未发生白癜风的患者在无进展生存期（PFS）和无远处转移生存期（DMFS）方面的差异。从2018年1月至2024年2月，通过回顾性和前瞻性研究从两家机构收集患者和数据。将患者分为“白癜风”组和“非白癜风”组进行比较。40例患者中，22.5%发生了ICI诱导的白癜风[中位随访时间：23个月（1 - 73个月）]。接受的治疗为纳武单抗（70%）和帕博利珠单抗（30%）。55%的患者完成了1年治疗，37.5%的患者停药，7.5%的患者仍在继续治疗。白癜风组和非白癜风组在治疗中断原因（白癜风组为严重毒性，非白癜风组为疾病进展，P = 0.005）和疾病进展发生率（白癜风组无进展，非白癜风组为52%，P = 0.001）方面存在差异。生存分析显示白癜风组的PFS更长（P = 0.013），而DMFS无差异（P = 0.111）。ICI诱导的白癜风通常累及光照暴露部位，中位发病时间为4个月（1 - 27个月）。这些关于辅助治疗中ICI诱导的白癜风的初步结果与晚期黑色素瘤治疗中报道的结果一致，因此其在辅助治疗中的发生也可能是预后良好的标志。
