Checkpoint inhibitor-induced sarcoid choroidal granulomas

Ung, Cindy; Gragoudas, Evangelos S.

doi:10.1016/j.ajoc.2020.100652

Cited by 12 publications

(19 citation statements)

References 22 publications

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“…Table 1 summarizes the studies reporting clinically evident sarcoidosis and SLRs related to ICIs therapy, published in the English literature so far, including information about the type of malignancy, type of ICI, sarcoidosis phenotype, type of treatment and survival of ICI. Including our patient, we were able to identify 80 individuals developing sarcoidosis or SLR in association to ICIs treatment 3‐54 . Based on these records, both sexes were equally affected (40 M/40F), whilst by far the most common malignancy was melanoma (65/80, 81.3%), with only 15 of 80 cases (18.8%) being other than melanoma tumors.…”

Section: Resultsmentioning

confidence: 99%

“…However, there is an on‐going controversy in regards with the relationship between sarcoidosis and malignancies, given that sarcoidosis may develop during the course of an oncologic disease and vice versa 1 . Furthermore, sarcoidosis, or sarcoid‐like reactions (SLRs) may develop in association to certain oncologic drugs, including immune checkpoint inhibitors (ICIs) 1,3‐54 . As expected, the aforementioned facts raise significant diagnostic and therapeutic challenges in oncologic patients treated with ICIs.…”

Section: Introductionmentioning

confidence: 99%

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Challenges in sarcoidosis and sarcoid‐like reactions associated to immune checkpoint inhibitors: A narrative review apropos of a case

Apalla

Kemanetzi

Papageorgiou

et al. 2020

Dermatologic Therapy

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Sarcoidosis and sarcoid‐like reactions (SLRs) may develop in association with various malignancies, as well as in association to certain oncologic drugs, including immune checkpoint inhibitors (ICIs). We aimed to perform a narrative review with regard to the development of ICIs‐associated sarcoidosis or SLRs, and to discuss the corresponding diagnostic and therapeutic challenges raised in this scenario. Apropos of a melanoma patient developing SLRs while treated with ipilimumab and nivolumab, we searched for clinically evident, ICIs‐associated sarcoidosis or SLRs in the English literature. We recorded the oncologic characteristics, including type of malignancy and type of ICI, the phenotypic characteristics of sarcoidosis/SLRs, as well as the impact on immunotherapy. Including our patient, we identified 80 ICIs‐associated sarcoidosis or SLRs cases. Both sexes were equally affected (40 F/40 M) and the most common malignancy was melanoma (65/80, 81.3%). Concerning the oncologic treatment, there was a predilection for pembrolizumab (23/80, 28.7%), followed by the ipilimumab/nivolumab combination (21/80, 26.3%), ipilimumab (18/80, 22.5%), nivolumab (16/80, 20.0%). Although in the majority of the cases (52/80, 65.0%) there was no need for systemic prednisolone for the management of sarcoidosis, a significant proportion of patients finally discontinued ICIs treatment (44/80, 55.0%). Phenotypically, sarcoidosis and SLRs highly imitate oncologic progression posing diagnostic difficulties. A therapeutic dilemma is also raised when there is a need for systemic prednisolone, since the latter may jeopardize the therapeutic efficacy of immunotherapy. Sarcoidosis and SLRs, though rare, can present in oncologic patients treated with ICIs. Clinicians should be aware of this possibility and the related diagnostic and therapeutic challenges they have to face in this scenario.

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Section: Resultsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Challenges in sarcoidosis and sarcoid‐like reactions associated to immune checkpoint inhibitors: A narrative review apropos of a case

Apalla

Kemanetzi

Papageorgiou

et al. 2020

Dermatologic Therapy

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“…Of the 26 cases, 16 reported racial demographics with 38% of patients being African American (6/16) [17,20,23,34,36], 38% Caucasian (6/16) [21,24,28,32,35,36], and 25% Asian (4/16) [26,27,29,33]. Among the 26 patients, 30 total eyes were affected, with 19% of patients having bilateral involvement (5/26) [16,18,25,32], and the majority having unilateral involvement [42% right eye (11/26) [15, 17, 20-22, 24, 26, 31, 34, 36], 38% left eye (10/26) [18, 19, 23, 27-30, 33, 35]]. The mean follow-up period was 27 months (median: 12, range: 1-216).…”

Section: Review Of the Literaturementioning

confidence: 99%

“…The most common visual complaint was a progressive painless blurring of vision (21/26) [15, 17, 18, 20, 21, 23-26, 28, 29, 31-34]. Other presentations included floaters (4/26) [15,18,20], eye pain (2/26) [23,32], headaches (2/26) [17,32], and those that were asymptomatic (5/26) [16,19,22,27,30].…”

Section: Review Of the Literaturementioning

confidence: 99%

“…Two men reported a prior history of prostate cancer, one treated with radiation therapy [20] and the other with radical prostatectomy [19]. Two patients (1 female, 1 male) had a prior history of melanoma, with one patient undergoing Nivolumab therapy for metastasis [16] and the other having 5 prior excisions for dermal melanoma [22].…”

Section: Past Medical Historymentioning

confidence: 99%

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Choroidal sarcoid granuloma: a case report and review of the literature

Hage

Wahab

Kheir

2022

J Ophthal Inflamm Infect

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Background Choroidal sarcoid granulomas are often diagnosed in patients without a prior history of sarcoidosis. They are often mistaken for choroidal metastasis, choroidal nevi, amelanotic choroidal melanomas, and uveal lymphomas; however, are easily treatable when accurately identified. Observations We searched PubMed, Medline, and Scopus for English-Language case reports published before September 2021. Additionally, we presented a case of a 45-year-old woman with a right-sided amelanotic choroidal mass whose diagnosis was delayed by a COVID-19 infection. Of the 26 cases reported in the literature, 46% were female, 38% were African American, and 19% had bilateral involvement. There was a mean age of 42.15 years and a mean follow-up period of 27 months. The most common complaint was of a progressive, painless blurring of vision, and only five patients had been previously diagnosed with sarcoidosis. The choroidal granulomas were typically described as yellow lesions, single or multiple, found temporal to or at the macula. Most patients were administered steroids, with 69% receiving them systemically, 5% topically, and 8% locally with a triamcinolone injection. All patients reported symptomatic improvement at their final follow-up with resolution of the mass in 65% of patients and improved visual acuity in 76%. Conclusion Primary testing including fundoscopy, fluorescein angiography, fundus autofluorescence, A/B-scan, and OCT are useful for diagnosis, differentiation from other choroidal lesions, and monitoring treatment response. Steroids are a mainstay of treatment for sarcoidosis and are effective at treating choroidal granulomas. Therefore, early recognition and diagnosis of choroidal granulomas is imperative as treatment can be curative and sight-sparing.

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Suspected immune checkpoint inhibitor‐induced pulmonary sarcoid reaction in metastatic renal cell carcinoma

Purcell

Preti

Fernandes

2022

Clinical Case Reports

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We present the case of a 50-year-old male patient with metastatic clear cell renal cell carcinoma (mRCC) who developed a diffuse pulmonary opacification and lymphadenopathy during nivolumab maintenance therapy. This was diagnosed as presumed sarcoid granulomatous inflammatory reaction secondary to immunotherapy, which resolved with holding off therapy and the nivolumab was resumed. K E Y W O R D Simmune-related adverse events, immunotherapy, metastatic renal cell carcinoma, sarcoid-like reactions How to cite this article: Purcell V, Preti B, Fernandes R. Suspected immune checkpoint inhibitor-induced pulmonary sarcoid reaction in metastatic renal cell carcinoma.

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Checkpoint inhibitor-induced sarcoid choroidal granulomas

Cited by 12 publications

References 22 publications

Challenges in sarcoidosis and sarcoid‐like reactions associated to immune checkpoint inhibitors: A narrative review apropos of a case

Challenges in sarcoidosis and sarcoid‐like reactions associated to immune checkpoint inhibitors: A narrative review apropos of a case

Choroidal sarcoid granuloma: a case report and review of the literature

Suspected immune checkpoint inhibitor‐induced pulmonary sarcoid reaction in metastatic renal cell carcinoma

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