Vitiligo-like leukoderma following cyclin-dependent kinase 4/6 inhibitor treatment - systematic review of the literature

Abstract

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

Objective: The aim of the study was to systematically review the characteristics of CDK4/6 inhibitor-induced vitiligo-like leukoderma.

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

Results: Thirteen publications met the inclusion criteria, for a study population of 62 patients, including the 3 newly reported patients attending our vitiligo clinic. All patients were female; median age was 61 years (range 39 to 87 years). Ribociclib was the CDK4/6 inhibitor most frequently associated with vitiligo-like leukoderma, in 75.8% of cases. The condition predominantly affected sun-exposed areas (87.8%) and caused symptoms such as intense pruritus in 63.6% of cases. Despite multiple treatment methods, 55.7% of the patients showed no repigmentation. CDK4/6 inhibitor therapy was discontinued in 13 patients (20.1%) for various reasons, including vitiligo-like leukoderma; however, cessation did not improve the outcome. Most studies lacked data on progression-free survival.

Conclusion: CDK4/6-inhibitor-induced vitiligo-like leukoderma has distinct clinical characteristics compared to 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.