Sarcoidosis-like reactions in cancer patients treated with immune checkpoint inhibitors: experience in a Spanish hospital

Torres-Jiménez, Javier; Esteban-Villarrubia, Jorge; García‐Abellás, Patricia; Cortés-Salgado, Alfonso; Soria-Rivas, Ainara; Gajate-Borau, P; Olmedo-García, María Eugenia; Fuente, Eduardo; Lage-Alfranca, Yolanda; Gómez-Rueda, Ana; Benito-Berlinches, Amparo; Gorospe‐Sarasúa, Luis; Garrido, Pilar

doi:10.1007/s12094-020-02546-w

Cited by 9 publications

(22 citation statements)

References 28 publications

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“…Indeed, only anecdotal observations of cSCC associated with granulomatous reactions have been made, and those developed independently of any treatment 9,10 . At the same time, the fact that SRs have been described as possible irAEs of ICI for other entitites together with the close correlation between the start of ICI treatment and the detection of SRs in the present case renders immunotherapy the most likely cause of the granulomatous reactions observed here 4–8 . SRs represent an atypical response pattern characterized by infiltration of lymphocytes and formation of granulomas, mainly in mediastinal and/or bilateral hilar lymph nodes and the lung parenchyma.…”

Section: Discussionmentioning

confidence: 60%

“…ground glass opacities) can also overlap with radiological findings frequently seen in ICI‐induced pneumonitis which is defined as the occurrence of respiratory symptoms (cough, dyspnoea etc.) together with newly developed inflammatory thoracic lesions revealed by CT scans during immunotherapy, after the exclusion of infections, tumour progress or other reasons 5,6,8,10 . Indeed, the correct classification of SRs can also be challenging, since they may mimic disease progression.…”

Section: Discussionmentioning

confidence: 99%

“…However, SRs have also been described in other tissues, such as the skin or bone marrow. [4][5][6][7][8] Murthi et al 7 recently reported a wide spectrum of thoracic SLRs, including possible sarcoid-like granulomas in mediastinal and bilateral hilar lymph nodes and in lung tissue, whereas parenchymal reticular opacities and lung fibrosis was also observed in some cases. Their observations indicate that thoracic SRs not only mimic tumour progression but can also be mistaken for pneumonitis, a relatively common irAE of anti-PD-1 agents.…”

Section: Discussionmentioning

confidence: 99%

“…[11][12][13] In the current literature, ICI-induced SRs are increasingly reported in various other cancer entities, in particular in malignant melanoma. [4][5][6][7][8][11][12][13] Notably, SRs have also been observed in patients treated with BRAF and/or MEK inhibitors. 7 The pathogenesis of ICI-induced SRs is unclear.…”

Section: Discussionmentioning

confidence: 99%

“…SRs are similar to sarcoidosis in terms of histology, clinical and radiological findings. The most commonly affected organs are hilar and mediastinal lymph nodes, lung parenchyma and the skin 4–8 . Here, we report the first case of thoracic SRs in a patient with metastatic cSCC successfully treated with anti‐PD‐1 agents.…”

Section: Introductionmentioning

confidence: 89%

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Development of thoracic sarcoid reactions associated with complete response to anti‐PD‐1 therapy in a patient with advanced cutaneous squamous cell carcinoma

Gambichler

Philippou

Scheel

et al. 2021

Acad Dermatol Venereol

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In patients with advanced cutaneous squamous cell carcinoma (cSCC), positive efficacy data were reported for anti‐PD‐1 antibodies. However, anti‐PD‐1 treatment is associated with a wide range of immune‐related adverse events (irAEs). Here, we report on a 78‐year‐old woman with a huge cSCC on the right cheek spanning from the temporal to the cervical region with evidence for infiltration of the parotid gland, right masseter muscle and right auditory canal. Ultrasound revealed cervical, submandibular and supraclavicular lymph node metastases on patient’s right side. On the basis of a medical hardship application, treatment with pembrolizumab was initiated. After two applications, a dramatic regression of the tumour was observed. At this point, the patient was switched to cemiplimab, which, in the meantime, had become available in Germany. After 3 months on cemiplimab, the tumour‐related ulcer on the right cheek showed almost complete regression and all previously affected lymph nodes displayed no evidence for malignancy. Thoracic computed tomography (CT) scans revealed enlarged mediastinal and bilateral hilar lymph nodes assessed as primarily reactive. Three months later, however, mediastinal and bilateral hilar lymph nodes further increased in size, accompanied by radiological alterations of the lung parenchyma. Lymph node biopsies revealed sarcoid reactions (SRs) including fibrotic non‐caseating epitheloid cell granulomas surrounded by lymphocytes. Since the patient did not display any clinical symptoms, cemiplimab treatment was continued following a 4‐week break. Three months later, CT showed significant regression of the described enlarged lymph nodes and parenchymal lung changes. Twenty months after anti‐PD‐1 treatment, the patient was still in complete remission. In conclusion, we describe, for the first time, the case of a patient with advanced cSCC who developed disseminated thoracic SRs which were associated with dramatic regression of tumour masses. Thus, as with other irAEs, development of SRs might be indicative of an anti‐tumour response to anti‐PD‐1 therapy.

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Section: Discussionmentioning

confidence: 60%

Section: Discussionmentioning

confidence: 99%