The development of vitiligo in melanoma patients on immunotherapy may predict improved survival, according to findings from a systematic review and meta-analysis.
In 137 studies reported between 1995 and 2013 and including 5,737 patients with stage III to IV melanoma who were treated with immunotherapy, the pooled cumulative incidence of vitiligo was 3.4%. In those with vitiligo for whom individual patient data were available, both progression-free and overall survival were significantly improved, compared with those without vitiligo after researchers adjusted for age and sex (hazard ratio, 0.51 and 0.25, respectively), Dr. Hansje-Eva Teulings of the University of Amsterdam and her colleagues reported online Jan. 19 in the Journal of Clinical Oncology.
Dr. Hansje-Eva Teulings
Immune-related effects after melanoma immunotherapy have been linked to increased clinical efficacy. Vitiligo, which results from “strong antimelanoma immunity that also targets healthy melanocytes as a result of shared expression melanocyte differentiation antigens,” is no exception, but it was unclear whether data from individual studies showing tumor regression and improved survival in those with vitiligo could be extrapolated to all immunotherapy studies, the investigators explained (J. Clin. Oncol. 2015 Jan. 19 [doi:10.1200/JCO.2014.57.4756]).
The current findings highlight the significance of vitiligo as a clinical marker for effective antimelanoma immunity and for improved clinical outcome, they said, concluding that “more awareness of vitiligo induction in patients with melanoma by oncologists may contribute to better recognition of patients with effective antimelanoma immunity and may influence their treatment options and prognosis.”