Durvalumab induced sarcoid‐like pulmonary lymphadenopathy

Abstract

Immune checkpoint inhibitors (ICIs) have become pivotal in the treatment of lung cancer. An increasing number of immune‐related adverse events (irAEs) have been recognized with their use. To our knowledge, this is the first published case of sarcoid‐like pulmonary lymphadenopathy associated with durvalumab, a monoclonal antibody against programmed death ligand‐1 (PD‐L1). A 76‐year‐old woman received adjuvant durvalumab for Stage IIA pT2aN1M0 (American Joint Committee on Cancer, Seventh edition) poorly differentiated lung adenocarcinoma. After three cycles, a sarcoid‐like granulomatous reaction was identified in mediastinal and hilar lymph nodes. Although the lymphadenopathy remained stable in size with the ongoing treatment, progressive intracranial metastases were identified after a further three cycles of durvalumab. Sarcoid‐like inflammation with the formation of non‐caseating granulomas in the absence of systemic sarcoidosis is an irAE which may mimic disease progression. Although a subset of patients who experience this reaction may have a favourable response to checkpoint inhibition, progression of disease may occur contemporaneously.

Durvalumab-Associated Granulomatous Reaction Mimicking Recurrence of Lung Cancer

“…2 Although several reports have indicated a possible association of other CPI antibodies with granulomatous reactions, 1,2 PD- L1inhibitor other than durvalumab has been implicated only in a single case of granulomatous reaction 3 and the case described the reaction in a patient with melanoma. With only one other reported case, 4 the current case represents the second report of such reaction with durvalumab in a patient with lung adenocarcinoma and may indeed represent a drug class effect. Granulomatous reactions may be concerning for recurrence of disease and may impact interventions and therapy.…”

Trastuzumab-related sarcoidosis in patient with breast adenocarcinoma: Case report and review of the literature

“…The main therapies involved in this reaction included interferon or peginterferon, TNF-alpha antagonists, and checkpoint immunological inhibitors, 55 drugs in total. In 62.1% (1,505 cases), the drug was the only possible causal factor for sarcoidosis, and the temporal relationship was consistent with medication-induced sarcoidosis [29]. Despite numerous reports of sarcoidosis and DISR following medical therapies, the immunopathological triggers involved have not, as yet, been characterized.…”

The Meaning of Lymphadenopathies During Adjuvant Durvalumab After Chemoradiotherapy for Lung Cancer: Thinking Beyond Disease Progression

“…Reports of SLR in lung cancer also increased in the past years, with an estimated incidence of around 3% [15]. This may be justified, among others, due to the widespread use of ICIs in this scenario, as their recent introduction significantly modified the therapeutic algorithm of this cancer, with significant improvements in patients' clinical results and health-related quality of life [16][17][18][19].…”