Vitiligo-like lesions in patients with advanced breast cancer treated with cycline-dependent kinases 4 and 6 inhibitors

Ribociclib-induced extensive vitiligo-like lesions: possible pathomechanisms with clinical, dermoscopic and histological correlation

“…Previous studies have reported that the onset of lesions is initially in the photo-exposed areas and an inflammatory phase with itching or erythema prior to the onset of vitiligo. Our patient developed pruritus and erythema prior to the development of vitiligo-like lesions and it occurred early (after seven cycles of ribociclib) compared with mean of nine cycles in a previous study 2. In our case, there were also areas of perifollicular hyperpigmentation within the vitiliginous macules, possibly because of immune privilege of the hair follicle or as a part of repigmentation.…”

“…CDK inhibitor-associated vitiligo-like depigmentation has mainly been described in patients on ribociclib. However, few cases have also been reported in patients on palbociclib 2. Pathomechanisms involving CDK inhibition induced melanocyte destruction are poorly understood but possible hypotheses include:…”

“…Over the past few years, there have been reports of various dermatological adverse events caused by these drugs. Common cutaneous adverse events include alopecia, pruritus, maculopapular rash and vitiligo-like lesions 2. Steven-Johnsons syndrome and erythema-dyschromicum-perstans-like-pigmentation have also been reported in patients on ribociclib 3 4…”

Vitiligo-Like Lesions in a Patient with Metastatic Breast Cancer Treated with Cyclin-Dependent Kinase (CDK) 4/6 Inhibitor: A Case Report and Literature Review

“…Sollena et al, on behalf of the European Network for Cutaneous ADverse event to Oncologic drugs (ENCADO) group, reported the largest series of vitiligo-like lesions associated with CDK4/6 inhibitors used in the treatment of 16 patients with mBC at six European university-based centers. 20 The majority of the patients were treated with topical steroids and/or topical calcineurin inhibitors, with variable response. The two other cases were reported by Chan et al, in 71- and 54-year-old women; both of them were treated with ribociclib and letrozole and neither had a personal or familial history of autoimmune diseases.…”

“…Vitiligo or vitiligo-like lesions are rarely reported with CDK4/6 inhibitors. 20 It is proposed that this adverse event may be due to the apoptotic effect of CDK4/6 inhibitors on melanocytes, which may result in reduced numbers and survival of melanocytes, and, consequently, the appearance of hypopigmented lesions. 21 …”