Aggravation of Depigmentation for a Non-Small-Cell Lung Cancer Patient with Pre-Existing Vitiligo Using Anti-Programmed Cell Death-1 Therapy: Case Report

Abstract

Immune checkpoint inhibitors can enhance the antitumor activity of the immune system by mainly promoting CD8+ T lymphocyte immune function. However, they can also induce immune-related adverse events, especially skin toxicity. Some studies found that patients with autoimmune or inflammatory disease are susceptible to immune checkpoint inhibitors and were associated with a significantly increased risk of immune-related adverse events. In our present report, we described a newly diagnosed non-small-cell lung cancer patient who suffered from focal vitiligo for approximately ten years and was treated with the anti-programmed cell death-1 receptor antibody camrelizumab (SHR-1210), which accelerated the aggravation of depigmentation of the skin over the whole body in just half a year.

Clinical profile of cutaneous adverse events of immune checkpoint inhibitors in a single tertiary center

“…Because both molecular‐targeted agents and ICI‐induced secondary tumors have been reported, whether PD‐1/PD‐L1 inhibitors alone could cause keratoacanthoma merits further study. It is interesting that vitiligo occurred only in melanoma patients in this study, although its association with ICI has been reported in many cancers such as squamous cell carcinoma, renal cell carcinoma, bladder cancer, and lung cancer, besides melanoma 33–39 . This may be because physicians did not pay attention to vitiligo in patients with cancer types other than melanoma in this retrospective study.…”

“…It is interesting that vitiligo occurred only in melanoma patients in this study, although its association with ICI has been reported in many cancers such as squamous cell carcinoma, renal cell carcinoma, bladder cancer, and lung cancer, besides melanoma. [33][34][35][36][37][38][39] This may be because physicians did not pay attention to vitiligo in patients with cancer types other than melanoma in this retrospective study. In rare cases, lichen planus-like eruptions, nail changes, ulcer, and perforating dermatosis having a causality with PD-1/PD-L1 inhibitors were found in this study.…”

The time window for the reversal of depigmentation from aggravation to recovery in a non-small-cell lung cancer patient with pre-existing vitiligo using anti-programmed cell death-1 therapy: A case report

“…At the stage of the application of the anti-PD-1 antibody, we observed that the patient’s skin depigmentation began to aggravate in just half a year. We recorded the imaging pictures with the most aggravated condition in October 2019 (about 22 months of using anti-PD-1 antibody) and have published them as a form of the case report ( 14 ).…”

“…We previously described a diagnosed NSCLC patient with focal vitiligo and her skin depigmentation aggravated in just half a year after the application of anti-PD-1 antibody. The case report was published in the journal of Immunotherapy ( 14 ). This time, we reported a gradual recovery status of vitiligo after discontinuation of ICIs, and provided a specific time reference, which should be a further supplementary explanation for follow-up after anti-PD-1 antibody withdrawal.…”