Thursday, November 5, 2015

Vitiligo...again associated with response to anti-PD1 in melanoma patients

Here is some research and previous posts I made on vitiligo and a concomitant response to melanoma...the latest being in Jan of 2015:  Vitiligo: a good prognostic indicator for melanoma

Now there's this:
Association of vitiligo with tumor response in patients with metastatic melanoma treated with pembrolizumab.  Hua, Boussemart, Mateus, et al.  JAMA Dermatol.  Oct 2015.

Vitiligo is an autoimmune skin disorder that reacts against melanocytes.  The association of vitiligo with tumor response in patients with melanoma who undergo immunotherapy has been reported but is still controversial. ... This prospective observational study was conducted from 1/1/12 - 9/24/13... 67 patients with metastatic melanoma who were given pembro in a phase 1 study were included and screened for the emergence of vitiligo...  Of the 67 pts, 17 (25%) developed vitiligo during pembro treatment and 50 (67%) did not.  An objective (complete or partial) response to treatment was associated with a higher occurrence of vitiligo (12 of 17 {71%} vs 14 of 50 {28%}).  The time of onset of vitiligo ranged from 52 to 453 days (median = 126) from start of treatment.  Of the 17 patients with vitiligo, 3 had a complete response, 9 had a partial response, and 3 had stable disease, and 2 had progressive disease at final f/u.  Vitiligo, a clinically visible immune-related event could be associated with clinical benefit of pembro treatment.

Interesting.  Clearly, in terms of response, the presence of vitiligo doesn't equal a sure thing, as 2 of these patients with vitiligo had progressive disease.  However, overall it remains a good sign.  Also....when looking back on the development of my best as I can figure, it began around 52 days after my first dose of nivo/Opdivo....which is in keeping with what was found in this study as well.  Again...time will tell....but it still seems to me....we need to find what in immunotherapy (be it ipi, IL2, Nivo or Pembro) triggers vitiligo and I think we will be closer to finding answers about what triggers a response to melanoma.
Hang in there, ratties! - c

1 comment:

  1. I have a "nice" discoloration on my face and abdomen. Was worried about it for awhile until I did a search on it @ ncbi and found similar research suggesting efficacy of immunotherapy associated with vitiligo. Sigh of relief, though as you have said, not a home run. Had not seen this direct correlation though to keytruda. Cool stuff. Found that coconut oil has helped alleviate discoloration on face that its probably a good idea to wear that proudly and thankfully. Leland @