Reactions 1251 - 9 May 2009

★YM-155

First report of vitiligo, in an elderly patient: casereport

A 78-year-old man with metastatic malignant melanomadeveloped vitiligo while receiving YM-155 in a phase IIclinical trial.

The man started treatment with YM-155 4.8 mg/m2/dayas a 168-hour continuous infusion after developing bonyand pelvic lymph node metastases. Several days after hisfirst cycle of treatment, he developed rapid depigmentationinvolving his hands and extending to his forearms [time toreaction onset not clearly stated]. Biopsy revealed that theperipheral depigmented areas contained perivascularlymphocytic infiltrates with mild exocytosis, andmelanocyte/melanoma-associated antigen recognised by T-cells (MART-1)-positive melanocytes were completelyabsent in the central areas of depigmentation. He receiveda second cycle of YM-155 three weeks after his first cycle.

A CT scan performed approximately 2 months afterenrolment in the trial revealed progressive metastaticdisease, and YM-155 was replaced with temozolomide thefollowing month. The man’s vitiligo persisted, and he diedof progressive malignant melanoma approximately5 months later.

Author comment: "The temporal relationship between theinitiation of treatment and subsequent loss of pigmentationsuggests that melanocytes were destroyed by YM-155treatment, either directly or indirectly."Fujita M, et al. Development of vitiligo during melanoma treatment with a novelsurvivin inhibitor: a case report and review of the literature. International Journalof Dermatology 48: 426-430, No. 4, 2009 - USA 801141203

» Editorial comment: A search of AdisBase, Medline andEmbase did not reveal any previous case reports of vitiligoassociated with YM-155. YM-155 was not contained in theWHO ADR database.

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Reactions 9 May 2009 No. 12510114-9954/10/1251-0001/$14.95 © 2010 Adis Data Information BV. All rights reserved