Pulmonary Sarcoid-Like Granulomatosis Induced by Ipilimumab

Berthod, Grégoire; Lazor, Romain; Letovanec, Igor; Romano, Emanuela; Noirez, Leslie; Mazza-Stalder, Jesica; Speiser, Daniel E.; Peters, Solange; Michielin, Olivier

doi:10.1200/jco.2011.39.3298

Cited by 178 publications

(102 citation statements)

References 21 publications

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“…Males exhibit higher incidence rates after the age of 44 years [2]. Patients diagnosed at an early stage can usually be treated with surgical excision with curative intent, and only a minority of these patients will develop metastatic disease [3,4]. The lifetime risk of developing melanoma is estimated to be 1 in 50 individuals [5].…”

Section: Introductionmentioning

confidence: 99%

Ipilimumab, not just another anti-cancer therapy: hypophysitis as side effect illustrated by four case-reports

et al. 2014

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Ipilimumab is a monoclonal antibody that blocks cytotoxic T-lymphocyte antigen4 (CTLA-4), an inhibitory molecule typically expressed on T cells. Blockade of CTLA-4 induces an overall activation of T cells, including an immune-mediated anti-tumour response. Unfortunately, this broad T cell stimulation also causes immune-related adverse events (irAEs), such as dermatitis, colitis, hepatitis and hypophysitis. Ipilimumab is currently available in Belgium as a second line of treatment for patients with advanced melanoma, and is used at a dose of 3 mg/kg of body weight, although higher doses were previously used (up to 10 mg/kg). We performed a retrospective analysis to identify melanoma patients treated with ipilimumab at the Ghent University Hospital between 2010 and 2013. Data on symptoms, stage and timing of ipilimumab, response and adverse events were collected with a special attention to endocrine disturbances, going from a limited involvement of one endocrine axis to development of a hypophysitis. We identified a total of 39 patients with stage III (No. = 7) or stage IV (No. = 32) melanoma, who received a dose of 3 (No. = 31) or 10 (No. = 8) mg/kg. Six patients developed a severe form of irAEs, including one case of colitis (2 %), one case of sarcoidosis (2 %) and 4 cases (10 %) of hypophysitis. Hypophysitis developed between the second and fourth cycle of ipilimumab administration and was independent of the dose used. We describe four cases of involvement of the pituitary gland during treatment with ipilimumab. When managed with vigilant monitoring and high-dose corticosteroids, the acute symptoms resolve, but lifelong hormone substitution therapy can be necessary. Involvement of the pituitary axes is a severe side effect of treatment with ipilimumab with an urgent need for the correct medical intervention.

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Section: Introductionmentioning

confidence: 99%

Ipilimumab, not just another anti-cancer therapy: hypophysitis as side effect illustrated by four case-reports

et al. 2014

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“…However, various ipilimumab-associated immune-related adverse events including enterocolitis, dermatitis, hepatitis, hypophysitis, meningo-radiculo-neuritis, and renal failure have been reported [3]. The few reported cases of pulmonary side-effects consist of ipilimumab-induced sarcoid-like granulomatosis [4][5][6][7]. To our knowledge, this is the first report of an ipilimumab-induced lung injury presenting as severe acute respiratory distress syndrome (ARDS).…”

Section: To the Editormentioning

confidence: 99%

Severe acute respiratory distress syndrome due to ipilimumab

et al. 2013

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“…For example, cases of sarcoid-like reactions have been reported following treatment of melanoma with interferon, vemurafenib, vaccine therapy, ipilimumab and nivolumab [9][10][11][12][13][14]. In our institutional experience, we have seen patients with concurrent melanoma and sarcoidosis both identified at the diagnosis of malignancy, and the development of sarcoid-like reactions, both symptomatic and asymptomatic from ICPI therapy [15].…”

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confidence: 91%

Sarcoidosis, Malignancy and Immune Checkpoint Blockade

Gaughan

2017

Immunotherapy

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Pulmonary Sarcoid-Like Granulomatosis Induced by Ipilimumab

Cited by 178 publications

References 21 publications

Ipilimumab, not just another anti-cancer therapy: hypophysitis as side effect illustrated by four case-reports

Ipilimumab, not just another anti-cancer therapy: hypophysitis as side effect illustrated by four case-reports

Severe acute respiratory distress syndrome due to ipilimumab

Sarcoidosis, Malignancy and Immune Checkpoint Blockade

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