Immune checkpoint inhibitor-induced sarcoidosis-like granulomas

Rambhia, Pooja H.; Reichert, Barbara; Scott, Jeffrey F.; Feneran, Ashley; Kazakov, Jordan; Honda, Kord; Koon, Henry; Gerstenblith, Meg R.

doi:10.1007/s10147-019-01490-2

Cited by 42 publications

(30 citation statements)

References 59 publications

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“…Functional lung tests performed in some cases showed either a moderate restrictive pattern and reduced carbon monoxide diffusing capacity [93] or were normal [101,102]. Patients developing ICI-induced sarcoid-like reactions were usually asymptomatic and the majority did not mandate permanent ICI discontinuation or systemic treatment [81,94,103], although ICI discontinuation and/or additional steroid treatment became necessary for resolution of granulomatous reactions in some cases. For cutaneous granulomatosis, topical steroids have been proven effective.…”

Section: Sarcoidosis and Sarcoid-like Reactionsmentioning

confidence: 99%

Rheumatic Manifestations in Patients Treated with Immune Checkpoint Inhibitors

Μελισσαρόπουλος

Klavdianou

Filippopoulou

et al. 2020

IJMS

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Immune checkpoint inhibitors (ICIs) are monoclonal antibodies that activate the immune system, aiming at enhancing antitumor immunity. Their clinical efficacy is well-documented, but the side effects associated with their use are still under investigation. These drugs cause several immune-related adverse events (ir-AEs), some of which stand within the field of rheumatology. Herein, we present a literature review performed in an effort to evaluate all publicly available clinical data regarding rheumatic manifestations associated with ICIs. The most common musculoskeletal ir-AEs are inflammatory arthritis, polymyalgia rheumatica and myositis. Non-musculoskeletal rheumatic manifestations are less frequent, with the most prominent being sicca, vasculitides and sarcoidosis. Cases of systemic lupus erythematosus or scleroderma are extremely rare. The majority of musculoskeletal ir-AEs are of mild/moderate severity and can be managed with steroids with no need for ICI discontinuation. In severe cases, more intense immunosuppressive therapy and permanent ICI discontinuation may be employed. Oncologists should periodically screen patients receiving ICIs for new-onset inflammatory musculoskeletal complaints and seek a rheumatology consultation in cases of persisting symptoms.

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Section: Sarcoidosis and Sarcoid-like Reactionsmentioning

confidence: 99%

Rheumatic Manifestations in Patients Treated with Immune Checkpoint Inhibitors

Μελισσαρόπουλος

Klavdianou

Filippopoulou

et al. 2020

IJMS

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“…The development of sarcoid‐like granulomas with checkpoint inhibition may mimic disease progression and pose a clinical conundrum which may impact treatment decisions. The most common sites of involvement are the mediastinal and hilar lymph nodes (71% of cases), lung parenchyma (60% of cases), and skin (54.5% of cases) .…”

Section: Discussionmentioning

confidence: 99%

“…Sarcoidosis is a granulomatous disease characterized by the formation of non‐caseating granulomas in multiple organ systems . Sarcoid‐like granulomatous inflammation is an uncommon irAE that has been associated with inhibition of cytotoxic T lymphocyte antigen‐4 (CTLA‐4) with ipilimumab, programmed death‐1 (PD‐1) with nivolumab and pembrolizumab, and PD‐L1 with atezolizumab and avelumab . We report a case of sarcoid‐like granulomatous lymphadenopathy associated with durvalumab, an anti‐PD‐L1 selective human immunoglobulin G1 (IgG1) monoclonal antibody in a woman with lung adenocarcinoma.…”

Section: Introductionmentioning

confidence: 99%

Durvalumab induced sarcoid‐like pulmonary lymphadenopathy

Sanderson

Wimaleswaran

Senko

et al. 2020

Respirology Case Reports

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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.

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“…Sarcoidosis presenting with hilar and mediastinal lymphadenopathy was reported in a lung cancer patient who received carboplatin/pemetrexed and pembrolizumab . T helper‐1 and T helper‐17 cells may play a role in the development of sarcoidosis . It is important to take a biopsy to differentiate sarcoidosis and disease progression.…”

Section: Toxicity Profilementioning

confidence: 99%

“…14 T helper-1 and T helper-17 cells may play a role in the development of sarcoidosis. 15 It is important to take a biopsy to differentiate sarcoidosis and disease progression. Most patients required discontinuation of therapy completely for a short period of time as well as immunosuppressant treatment.…”

Section: Toxicity Profilementioning

confidence: 99%

Management of immune checkpoint inhibitor‐related adverse events: A review of case reports

Song

et al. 2020

Thoracic Cancer

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Immune checkpoint inhibitors represent a major breakthrough in cancer therapy. Immune‐related adverse events (irAEs) may occur during treatment due to their unique mechanism of action. Management of irAEs is based on clinical experience because it is not easy to conduct prospective trials to evaluate the best treatment strategy. Using a combination of search terms in the PubMed and Embase databases, we reviewed all cases in the English language citing toxicities associated with either pembrolizumab, nivolumab, ipilimumab, atezolizumab, tremelimumab, durvalumab, avelumab or any combination of these agents published before 20 May 2019. A total of 128 reports with 239 cases were included in the study. Here, we summarize the spectrum of toxicities, safety in special patients, rechallenging after irAEs and agents used for treatment of irAEs in those reports.

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Immune checkpoint inhibitor-induced sarcoidosis-like granulomas

Cited by 42 publications

References 59 publications

Rheumatic Manifestations in Patients Treated with Immune Checkpoint Inhibitors

Rheumatic Manifestations in Patients Treated with Immune Checkpoint Inhibitors

Durvalumab induced sarcoid‐like pulmonary lymphadenopathy

Management of immune checkpoint inhibitor‐related adverse events: A review of case reports

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