Vitiligo-like leucoderma following cyclin-dependent kinase 4 and 6 inhibitor treatment: systematic review of the literature

Abstract

Background: Vitiligo-like leucoderma is being increasingly reported in patients with breast cancer treated with cyclin-dependent kinase 4 and 6 (CDK4/6) inhibitors.

Objectives: To systematically review the characteristics of CDK4/6 inhibitor-induced vitiligo-like leucoderma.

Methods: A comprehensive literature search was conducted to identify published cases of patients with vitiligo-like leucoderma following CDK4/6 inhibitor therapy administered for advanced breast cancer. The cases of three additional patients from our tertiary vitiligo clinic are also reported.

Results: Thirteen publications met the inclusion criteria, with a study population of 62 patients, including the 3 newly reported patients attending our vitiligo clinic. All patients were female; the median age was 61 years (range 39-87 years). Ribociclib was the CDK4/6 inhibitor most frequently associated with vitiligo-like leucoderma in 76% of patients (47/62). The condition predominantly affected sun-exposed areas (88%, 36/41) and caused symptoms such as intense pruritus in 59% of patients (24/41). Despite multiple treatment methods, 56% of the patients (34/61) showed no repigmentation. CDK4/6 inhibitor therapy was discontinued in 13 of 62 patients (21%) for various reasons, including vitiligo-like leucoderma; however, cessation did not improve the outcome. Most studies lacked data on progression-free survival.

Conclusion: CDK4/6-inhibitor-induced vitiligo-like leucoderma has distinct clinical characteristics compared with classic vitiligo and is mostly recalcitrant to treatment. Stopping CDK4/6 inhibitors does not alleviate or improve the condition. Further research is essential to elucidate its prognostic significance.