EBUS-TBNA Can Distinguish Sarcoid-Like Side Effect of Nivolumab Treatment from Tumor Progression in Non-Small Cell Lung Cancer

Lainez, S.; Tissot, Claire; Cottier, Michèle; Vergnon, Jean‐Michel

doi:10.1159/000480155

Cited by 27 publications

(18 citation statements)

References 15 publications

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“…Concerning clinical presentation, the time to onset was 12 weeks, and the patients were most often asymptomatic or developed dyspnoea, cough or asthenia [112][113][114][115][116][117][118][119][120][121][122][123][124][125][126][127][128]. Thoracic CT scans revealed stage I-II sarcoidosis-like presentation in 14 of the 19 patients (73.6%) (figure 2c).…”

Section: Ici-related Sarcoid-like Granulomatosismentioning

confidence: 99%

“…Thoracic CT scans revealed stage I-II sarcoidosis-like presentation in 14 of the 19 patients (73.6%) (figure 2c). However, atypical lesions were observed, such as ground-glass opacities (n=5) (figure 2d) and low abundance pleural effusion (n=2) [112][113][114][115][116][117][118][119][120][121][122][123][124][125][126][127][128]. Extrathoracic involvement was observed in 10 (52.6%) patients, of whom nine had melanoma, with lesions affecting skin (n=5), spleen (n=3), eyes and parotid gland (n=1) and brain (n=1) [114][115][116][117][118][120][121][122][123][124], in line with sarcoidosis presentation [133].…”

Section: Ici-related Sarcoid-like Granulomatosismentioning

confidence: 99%

“…Pulmonary function tests were normal among the few evaluated patients (n=6) [112,113,118,120,121,123]. Granulomatosis lesions were obtained by bronchial biopsy, TBLB or mediastinal lymph nodes biopsies using endobronchial ultrasound in most cases (n=15), or by skin or other tissue biopsies in others [112][113][114][115][116][117][118][119][120][121][122][123][124][125][126][127][128]. BAL composition, when performed (n=6), usually showed lymphocytic alveolitis with a high CD4/CD8 ratio [112,114,117,118,121,123,134].…”

Section: Ici-related Sarcoid-like Granulomatosismentioning

confidence: 99%

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Pulmonary complications of immune checkpoint inhibitors in patients with nonsmall cell lung cancer

et al. 2019

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Immune checkpoint inhibitor-related pneumonitis (ICI-P) during cancer treatment is rarely observed (<5%). ICI-P is more often observed in patients with nonsmall cell lung cancer (NSCLC) than in those with other cancers. Likewise, it is more common in those receiving programmed cell death (PD)-1/PD-1 ligand inhibitors rather than cytotoxic T-lymphocyte antigen (CTLA)-4 inhibitors alone. The frequency of ICI-P is higher when anti-PD-1 and anti-CTLA-4 are administered concomitantly. Despite the low fatality rate (≈13%), ICI-P is the leading cause of ICI-related deaths. This narrative review focuses on the epidemiology, clinical and radiological presentation and prognosis of ICI-P occurring in patients, especially those with advanced NSCLC. Emphasis is placed on the differences in terms of frequency or clinical picture observed depending on whether the ICI is used as monotherapy or in combination with another ICI or chemotherapy. Other pulmonary complications observed in cancer patients, yet not necessarily immune-related, are reviewed, such as sarcoid-like granulomatosis, tuberculosis or other infections. A proposal for pragmatic management, including differential diagnosis and therapeutic strategies, is presented, based on the ICI-P series reported in the literature and published guidelines.

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Section: Ici-related Sarcoid-like Granulomatosismentioning

confidence: 99%

Section: Ici-related Sarcoid-like Granulomatosismentioning

confidence: 99%

Section: Ici-related Sarcoid-like Granulomatosismentioning

confidence: 99%

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Pulmonary complications of immune checkpoint inhibitors in patients with nonsmall cell lung cancer

et al. 2019

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“…For lung cancer, there have been reports of skin sarcoidosis during the treatment with nivolumab alone or in combination with ipilimumab [6, 7]. Moreover, granulomatous lesions have been observed in the mediastinal lymph node with the use of nivolumab alone [8]. However, the present case may be the first case to demonstrate granuloma development in the lung.…”

Section: Discussionmentioning

confidence: 69%

Sarcoid-Like Granulomatosis Induced by Nivolumab Treatment in a Lung Cancer Patient

Noguchi¹,

Kawachi²,

Yoshida³

et al. 2018

Case Rep Oncol

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Nivolumab, an anti-PD-1 antibody, inhibits binding between PD-1 and PD-1 ligand and activates antigen-specific T cells that have become unresponsive to cancer cells. Although it is recommended as a second-line therapy in gene mutation-negative non-small-cell lung cancer, interstitial pneumonia is a well-known side effect of the drug; however, granulomatous lesions have rarely been reported. We describe the case of an 81-year-old male with cT1aN2M1b stage IV pleomorphic carcinoma of the left upper lobe of the lung. After primary treatment with carboplatin and paclitaxel, recurrence was observed in the left supraclavicular lymph node and left adrenal gland. We initiated the administration of nivolumab as a secondary treatment. Reduction was observed in the swelling of the left supraclavicular lymph node and left adrenal gland, but the tumor shadow in the right upper lobe appeared to increase. Bronchoscopy was performed, and the biopsy result showed granulomas; the findings resembled a sarcoid-like granulomatous reaction. The shadows eventually disappeared with nivolumab discontinuation; thus, we concluded that the sarcoid-like granulomatous reaction had resulted from nivolumab administration. Based on our observations, we suggest that when invasive shadows are observed after nivolumab administration, it is necessary to differentiate between disease progression and interstitial pneumonia. Moreover, the decision to reinitiate nivolumab treatment requires careful judgment in future instances of cancer recurrence.

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“…The granulomas are typically composed of epithelioid cells, giant cells, CD4+ T‐lymphocytes at the centre, and CD8+ T‐lymphocytes and B‐lymphocytes at the periphery, surrounded by a fibrotic rim in sarcoidosis . In sarcoid‐like reaction, this rim may be lacking . Obviously, sarcoid‐like reaction produces a similar pattern on BAL compared to sarcoidosis.…”

mentioning

confidence: 99%

Diagnostic yield of broncho‐alveolar lavage for pembrolizumab induced sarcoid‐like reaction of the lung

Grosse

2019

Cytopathology

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Immune checkpoint inhibitors may cause sarcoid‐like reaction of the lung. Broncho‐alveolar lavage demonstrates lymphocytosis in this setting; the CD4+/CD8+ ratio was not increased in the current case. This pattern is similar, but not identical to sarcoidosis. Drug‐induced pneumonitis, tumour recurrence or pneumonia, the main differential diagnoses for sarcoid‐like reaction, can reliably be distinguished using broncho‐alveolar lavage.

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EBUS-TBNA Can Distinguish Sarcoid-Like Side Effect of Nivolumab Treatment from Tumor Progression in Non-Small Cell Lung Cancer

Cited by 27 publications

References 15 publications

Pulmonary complications of immune checkpoint inhibitors in patients with nonsmall cell lung cancer

Pulmonary complications of immune checkpoint inhibitors in patients with nonsmall cell lung cancer

Sarcoid-Like Granulomatosis Induced by Nivolumab Treatment in a Lung Cancer Patient

Diagnostic yield of broncho‐alveolar lavage for pembrolizumab induced sarcoid‐like reaction of the lung

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