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Immune checkpoint inhibitors (ICIs) immensely improved outcomes in melanoma patients. Vitiligo-like depigmentation (VLD) is a well-documented adverse event of ICIs which is well tolerated and often associated with prolonged response to treatment. The aim of this study was to assess the effect of VLD occurrence on survival in melanoma patients treated with ICIs.
We conducted a retrospective analysis among unresectable stage III and stage IV melanoma patients treated with pembrolizumab or nivolumab at the University Clinical Center Niš from May 2017 to February 2024. The Chi-square or Fisher’s exact test were used to evaluate the categorical variables. Progression-free survival (PFS) and overall survival (OS) were estimated using the Kaplan–Meier method (CI 95%; p <0.05). Survival between the patients with or without VLD was compared using a log-rank (p < 0.05).
A total of 109 patients were included, including 22 patients who developed VLD (20.2%). Median follow-up in the VLD group was 39.4 months, with 59% still alive and progression-free three years after treatment initiation. The overall response rate (ORR) was 72.7% vs. 29.9%, with 31.8% vs. 13.8% of complete responses in favor of the VLD subgroup. The occurrence of VLD was associated with significantly longer median PFS (8.148 vs. 52.862 months; p=0.0001) and median OS (12.715 vs. NR months; p=0.0001).
Prediction of VLD occurrence is not possible, therefore, it cannot be a predictive parameter per se, however, it can be associated with prolonged response to ICI treatment in patients who develop this adverse event.
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