title: Enhanced survival associated with vitiligo expression during maintenance biotherapy for metastatic melanoma.
abstract: Vitiligo, an autoimmune skin disorder, was evaluated in 49 metastatic melanoma patients treated with an immunotherapy regimen of maintenance biotherapy (mBT) following induction concurrent biochemotherapy (cBCT). Patients receiving mBT demonstrated a stable or better response to cBCT. The mBT regimen consisted of outpatient subcutaneous injections of low-dose IL-2 (1 MIU/m(2)) 5/7 days weekly, GM-CSF (125 mcg/m(2)) 14 days monthly, and high-dose pulses of in-patient continuous infusion decrescendo IL-2 (54 MIU/m(2)) over 48 hours monthly for the first 6 months and every 2 months thereafter. The majority of patients had poor prognostic features. Forty-nine patients were without evidence of vitiligo at the start of mBT. Of these, 21 patients (43%) developed vitiligo during mBT and had a median overall survival from the start of mBT of 18.2 months (95% CI, 12.3-N/A) compared to 8.5 months (95%CI <6.7-12.7) for 28 non-vitiligo patients (P=0.027). Six of 21 vitiligo patients (29%) expressed IgG antibody titers to tyrosinase-related protein-2 compared to four of 28 non-vitiligo patients (14%) (P=NS). The development of vitiligo in metastatic melanoma patients on cBCT/mBT immunotherapy correlates with a better therapeutic outcome.
authors.affiliation: The Angeles Clinic and Research Institute, Santa Monica, California 90404, USA. pboasberg@theangelesclinic.org
authors.forename: Peter D
authors.initials: PD
authors.lastname: Boasberg
authors.forename: Dave S B
authors.initials: DS
authors.lastname: Hoon
authors.forename: Lawrence D
authors.initials: LD
authors.lastname: Piro
authors.forename: Maureen A
authors.initials: MA
authors.lastname: Martin
authors.forename: Akhide
authors.initials: A
authors.lastname: Fujimoto
authors.forename: Timothy S
authors.initials: TS
authors.lastname: Kristedja
authors.forename: Sandeep
authors.initials: S
authors.lastname: Bhachu
authors.forename: Xing
authors.initials: X
authors.lastname: Ye
authors.forename: Regina R
authors.initials: RR
authors.lastname: Deck
authors.forename: Steven J
authors.initials: SJ
authors.lastname: O'Day
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000906:Antibodies / Q000097:blood; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D001691:Biological Therapy / Q000009:adverse effects*; D016543:Central Nervous System Neoplasms / Q000276:immunology / Q000401:mortality / Q000556:secondary* / Q000628:therapy*; D005260:Female; D016178:Granulocyte-Macrophage Colony-Stimulating Factor / Q000008:administration & dosage / Q000627:therapeutic use; D006801:Humans; D007260:Infusion Pumps; D007279:Injections, Subcutaneous; D007376:Interleukin-2 / Q000008:administration & dosage / Q000627:therapeutic use; D008297:Male; D008545:Melanoma / Q000276:immunology / Q000401:mortality / Q000556:secondary* / Q000628:therapy*; D008565:Membrane Proteins / Q000276:immunology; D008875:Middle Aged; D010446:Peptide Fragments / Q000276:immunology; D016019:Survival Analysis; D014820:Vitiligo / Q000209:etiology*
chemical_list: D000906:Antibodies; D007376:Interleukin-2; D008565:Membrane Proteins; D010446:Peptide Fragments; C500290:peptide SVYDFFVWL; D016178:Granulocyte-Macrophage Colony-Stimulating Factor