Sarcoidosis complicating anti-cytotoxic T-lymphocyte-associated antigen-4 monoclonal antibody biotherapy

Tissot, Claire; Carsin, A.; Freymond, N.; Pachéco, Yves; Devouassoux, Gilles

doi:10.1183/09031936.00107912

Cited by 54 publications

(37 citation statements)

References 12 publications

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“…Six cases of ipilimumab-induced sarcoidosis-like reactions in melanoma patients have previously been reported. [3][4][5][6][7][8] Three patients received ipilimumab 3 mg/kg and 3 patients received ipilimumab 10 mg/kg. In all cases the lungs and mediastinum was affected and in addition 3 of the patients presented with cutaneous lesions with histopathologic features resembling sarcoidosis.…”

Section: Discussionmentioning

confidence: 99%

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Late development of splenic sarcoidosis-like lesions in a patient with metastatic melanoma and long-lasting clinical response to ipilimumab

et al. 2014

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A male patient with Stage IV melanoma was treated with ipilimumab resulting in a long-lasting partial response according to RECIST criteria. However, twenty months after ipilimumab treatment, routine follow-up CT scan revealed new splenic lesions initially interpreted as indicative of progressive disease. Nevertheless, a biopsy was performed and histologic evaluation showed that the lesions did not contain malignant cells but rather constituted non-caseating epithelioid cell granulomas consistent with sarcoidosis. As the patient was asymptomatic no treatment was initiated and over the following months the splenic lesions slowly disappeared and to date the patient remains in remission. Ipilimumab is now widely used in the treatment of melanoma patients. Our case-report illustrates that physicians should consider the possibility of ipilimumab induced visceral sarcoidosis-like reactions, mimicking metastatic lesions, developing even many months after ipilimumab treatment. Thus, biopsy of such suspicious lesions is advisable to avoid misinterpretation as disease progression and unnecessary resumption of cancer therapy.

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Section: Discussionmentioning

confidence: 99%

“…The past few years a small number of cases of ipilimumab-induced sarcoidosis-like reactions in lung and mediastinum have been reported. [3][4][5][6][7][8] Here we report a case of late sarcoidosis-like granulomatosis of the spleen in a patient previously treated with ipilimumab for metastatic melanoma.…”

Section: Introductionmentioning

confidence: 99%

Late development of splenic sarcoidosis-like lesions in a patient with metastatic melanoma and long-lasting clinical response to ipilimumab

et al. 2014

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“…Previous case reports [9,10,11,17,18] have documented the development of sarcoidosis in patients being treated with ipiliumumab. However, to our knowledge, the development of neurosarcoidosis has not been previously reported as a complication.…”

Section: Discussionmentioning

confidence: 99%

New-Onset Mediastinal and Central Nervous System Sarcoidosis in a Patient with Metastatic Melanoma Undergoing CTLA4 Monoclonal Antibody Treatment

Murphy

Kennedy²,

Barry³

et al. 2014

Oncol Res Treat

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SummaryBackground: Ipilimumab, a cytotoxic monoclonal antibody that inhibits cytotoxic T lymphocyte-associated antigen-4 (CTLA-4), has been established as an effective therapy in the management of advanced melanoma. Immune-mediated adverse events are a common side effect. Case Report: A 37-year-old male patient was diagnosed with nodal and osseous metastatic melanoma 15 months after the initial surgical treatment for lower limb melanoma. Therapy with the anti-CTLA-4 antibody, ipilimumab, was started. Follow-up staging imaging after treatment initiation showed symmetrical bihilar adenopathy. Transbronchial biopsy showed sarcoidosis. The patient had associated systemic symptoms of fatigue, joint pains, anorexia and weight loss. Brain magnetic resonance imaging (MRI), which was performed for the investigation of headaches, showed abnormal enhancing tissue in the sella turcica and adjacent to the pituitary infundibulum, consistent with neurosarcoidosis. The condition was successfully treated with corticosteroids. Conclusions: We report a case of immunotherapy-induced mediastinal/hilar sarcoidosis, with pituitary involvement, mimicking tumour progression. This highlights the need for awareness amongst radiologists and oncologists of the mechanism of action and potential side effects of new immunotherapies.

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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%

“…Most of the side-effects are considered of a mild or moderate degree, with dermatitis (up to 43%) and enterocolitis (30%) being the most frequent entities. Aside from ipilimumab-induced sarcoidlike granulomatosis of the lung [4][5][6][7], reports on pulmonary toxicity are not available. In a randomised, double-blind, phase three study enrolling 511 patients with stage III or IV melanoma treated with ipilimumab 12.7% reported dyspnoea and 0.6% experienced severe dyspnoea [2].…”

Section: To the Editormentioning

confidence: 99%

Severe acute respiratory distress syndrome due to ipilimumab

et al. 2013

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Sarcoidosis complicating anti-cytotoxic T-lymphocyte-associated antigen-4 monoclonal antibody biotherapy

Cited by 54 publications

References 12 publications

Late development of splenic sarcoidosis-like lesions in a patient with metastatic melanoma and long-lasting clinical response to ipilimumab

Late development of splenic sarcoidosis-like lesions in a patient with metastatic melanoma and long-lasting clinical response to ipilimumab

New-Onset Mediastinal and Central Nervous System Sarcoidosis in a Patient with Metastatic Melanoma Undergoing CTLA4 Monoclonal Antibody Treatment

Severe acute respiratory distress syndrome due to ipilimumab

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