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E-IJD® - CORRESPONDENCE |
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| Year : 2022 | Volume
: 67
| Issue : 6 | Page : 837 |
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| Tislelizumab induced vitiligo-like depigmentation in a Chinese patient with oesophageal squamous cell carcinoma |
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Ping Li, Qianwen Shao, Lianke Liu
Department of Oncology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| Date of Web Publication | 23-Feb-2023 |
Correspondence Address:
Lianke Liu
Department of Oncology, The First Affiliated Hospital of Nanjing Medical University, Nanjing
China
 Source of Support: None, Conflict of Interest: None  | Check |
DOI: 10.4103/ijd.ijd_60_22
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How to cite this article:
Li P, Shao Q, Liu L. Tislelizumab induced vitiligo-like depigmentation in a Chinese patient with oesophageal squamous cell carcinoma. Indian J Dermatol 2022;67:837 |
How to cite this URL:
Li P, Shao Q, Liu L. Tislelizumab induced vitiligo-like depigmentation in a Chinese patient with oesophageal squamous cell carcinoma. Indian J Dermatol [serial online] 2022 [cited 2023 Mar 23];67:837. Available from: https://www.e-ijd.org/text.asp?2022/67/6/837/370327 |
Sir,
Tislelizumab is a programmed death receptor-1 (PD-1) immune checkpoint inhibitor (ICI) antibody that is being developed by BeiGene and is approved for classical Hodgkin's lymphoma.[1] It exhibits a variety of adverse effects which are described as immune-related adverse events (irAEs) including pneumonia, diarrheoa and enteritis, hepatitis, nephritis, endocrine disorders, dermatologic toxicity and so on. Of which, dermatologic toxicity is the most common irAE such as rash, pruritus, and vitiligo. Vitiligo-like depigmentation was first proposed in patients with melanoma receiving immunotherapy. However, there is no related report on oesophageal cancer. Here we report a case of vitiligo-like depigmentation in a patient with esophageal squamous cell carcinoma receiving tislelizumab therapy as a part of phase III clinical trial. This patient is a 66-year-old man diagnosed with oesophageal squamous cell carcinoma in October 2019. The patient underwent surgery for gastric cancer in 2017 and denied no personal or family history of vitiligo or other autoimmune disorders. The treatment was started in November 2019 with six cycles of tislelizumab (200 mg/cycle, q3w) plus cisplatin and paclitaxel given every 3 weeks, followed by tislelizumab (200 mg) every 3 weeks. During the treatment period, the drug was suspended five times due to a novel coronavirus outbreak and some adverse effects such as anaemia according to the requirements of the clinical trial. Approximately five months after initiating tislelizumab, the patient noticed vitiligo-like depigmentation gradually appearing along his head, face, dorsal hands, trunk, and lower legs [Figure 1]. After exposure to the sun, the depigmentation part on the face and dorsal hands turn red [Figure 1]. Wood's lamp exposure confirmed the vitiligo-like depigmentation [Figure 2]. Three 5 mm punch biopsies were taken, one from an early depigmented patch on his right foot, one from a mid-term depigmented patch on his left dorsal hand and one from a newly depigmented patch on his right thigh [Figure 3]. Reduction or loss of melanocytes can be seen in the tissue. Computed tomography (CT) scan showed stable oesophageal disease without progression. Sun protection was recommended and immunotherapy continued without therapeutic intervention. | Figure 1: Photographs showing vitiligo-like depigmentation. Depigmentation appeared on his face, head and dorsal hands (a, b and c), lower legs, back and thorax (d, e and f)
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 | Figure 2: An area of back depigmentation on wood's lamp examination (a and b)
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 | Figure 3: Histopathology presenting less melanocytes in lesional skin (haematoxylin and eosin, original magnification × 100). An early depigmented patch on his right foot (a), a mid-term depigmented patch on his left dorsal hand (b) and a newly depigmented patch on his right thigh (c)
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Vitiligo, including non-segmental and segmental forms, is the most common depigmentation disorder, accounting for 0.5-2% of the general population.[2],[3] However, the precise mechanism is still unknown. Larsabal and colleagues[4] found that immunotherapy-induced vitiligo-like depigmentation is different from vitiligo clinically and biologically. First, the incidence is different. Secondly, patients with vitiligo always have a personal or family history of autoimmune disorders, while patients with vitiligo-like depigmentation do not have such a history. Thirdly, vitiligo is typically distributed symmetrically with the Koebner phenomenon and vitiligo-like depigmentation is presented in an asymmetric pattern without that phenomenon. Fourthly, compared with vitiligo patients, serum C-X-C motif ligand 10 (CXCL10) levels were significantly higher in patients with vitiligo-like depigmentation. Vitiligo-like depigmentation is associated with clear survival benefits in patients with melanoma receiving immunotherapy.[5] In our study, the patient received tislelizumab for nearly 2 years with a durable stabilisation, suggesting the same survival benefit in oesophageal squamous cell carcinoma.
Declaration of patient consent
The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.
Financial support and sponsorship
Nil.
Conflicts of interest
There are no conflicts of interest.
 References | |  |
| 1. | Lee A, Keam SJ. Tislelizumab: First approval. Drugs 2020;80:617-24.  |
| 2. | Ezzedine K, Eleftheriadou V, Whitton M, van Geel N. Vitiligo. Lancet 2015;386:74-84. |
| 3. | Picardo M, Dell'Anna ML, Ezzedine K, Hamzavi I, Harris JE, Parsad D, et al. Vitiligo. Nat Rev Dis Primers 2015;1:15011. doi: 10.1038/nrdp. 2015.11. |
| 4. | Larsabal M, Marti A, Jacquemin C, Rambert J, Thiolat D, Dousset L, et al. Vitiligo-like lesions occurring in patients receiving anti-programmed cell death-1 therapies are clinically and biologically distinct from vitiligo. J Am Acad Dermatol 2017;76:863-70. |
| 5. | Teulings HE, Limpens J, Jansen SN, Zwinderman AH, Reitsma JB, Spuls PI, et al. Vitiligo-like depigmentation in patients with stage III-IV melanoma receiving immunotherapy and its association with survival: A systematic review and meta-analysis. J Clin Oncol 2015;33:773-81. |
[Figure 1], [Figure 2], [Figure 3] |
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