Hair Repigmentation Observed in NSCLC Patients Receiving PD-L1 Therapy

Researchers in Spain discovered a strange side effect of PD-L1 immunotherapy in some NSCLC patients-hair repigmentation-that may be a good response marker for this treatment.

Spanish researchers are reporting a novel finding involving hair repigmentation in patients undergoing cancer treatment. Instead of turning hair grey, immunotherapy is darkening some patients’ hair. In addition, the investigators have found that hair repigmentation may be a good response marker in patients receiving anti–PD-1/anti–PD-L1 therapy for lung cancer. Writing in JAMA Dermatology, the researchers from Badalona, Spain report on a series of 14 patients (13 men and 1 woman) in which they observed hair repigmentation during anti–PD-1/anti–PD-L1 therapy for non–small-cell lung cancer (NSCLC).

The physicians compared old photos of the patients and recent pictures taken during treatment follow-up. They found that hair repigmentation consisted of a diffuse darkening of the hair in 13 of 14 patients. In one patient, black patches appeared between white hairs.

All the patients were treated between September and December of 2016 in the dermatology department at Hospital Universitari Germans Trias i Pujol, Badalona, Spain. The clinicians found that 13 of the 14 patients had a good clinical response to the treatment, with at least stable disease. One patient had to stop therapy after only 4 cycles of treatment due to disease progression.

The researchers believe this is the first report of hair repigmentation while being treated with anti–PD-1/anti–PD-L1 therapy for NSCLC. It was a rather surprising finding because patients with melanoma receiving anti–PD-1 therapies are known to develop vitiligo involving their hair, according to the researchers.

“Hair and skin pigmentation are linked to immunity. It is interesting to note that the phenomenon appears to be more likely to occur in men. It may be related to X-linked genes. Further research is needed to understand the phenomenon and to explore the potential to treat grey hair,” said June Robinson, MD, who is a research professor of dermatology at Northwestern University Feinberg School of Medicine, Chicago, Illinois.

The authors note that while hair repigmentation is rare, it has been reported with drugs such as thalidomide, lenalidomide, erlotinib, adalimumab, and etretinate.

The mechanisms of action of hair repigmentation have not been clear. Some theories suggest that inhibition of proinflammatory cytokines may function as negative regulators of melanogenesis, which is the production of melanin pigments. “The clinical implication is the biologic possibility that the immune modulation induced by anti-PD1 antibodies in male patients with an X-linked gene polymorphism may be linked to an antitumor efficacy,” said Dr. Robinson.