[Sarcoid-like granulomatosis in cancer patients treated with immune checkpoints inhibitors]

Rev Mal Respir. 2018 Nov;35(9):963-967. doi: 10.1016/j.rmr.2018.08.003. Epub 2018 Sep 13.
[Article in French]

Abstract

Introduction: Immune checkpoint inhibitors are becoming a standard treatment for many different cancers. Their toxicities are variable and include organ-specific dysimmune injuries and the development of systemic diseases.

Case report: We report 3 cases of sarcoid-like granulomatosis that occurred during treatment of various types of primary cancer by immune checkpoint inhibitors: lung adenocarcinoma, small cell lung cancer and melanoma. The clinical presentation, radiologic pattern and severity of this toxicity were variable. The diagnosis was made on biopsy with pathological examination and exclusion of differential diagnoses, particularly infection. In such cases, immunotherapy should be discontinued and subsequent rechallenge discussed later. Systemic corticosteroids should be considered depending on the severity of symptoms.

Conclusions: Knowledge of this toxicity is crucial as the clinical signs and radiological patterns may suggest tumour progression.

Keywords: Anti-PD-1/PD-L1; Granulomatose; Granulomatosis; Immune-related adverse events; Immunotherapy; Immunothérapie; Inhibiteurs de checkpoints immunitaires; PD-1/PD-L1 inhibitors; Toxicity; Toxicité.

Publication types

  • Case Reports

MeSH terms

  • Antibodies, Monoclonal / adverse effects*
  • Antibodies, Monoclonal / therapeutic use
  • Antineoplastic Agents, Immunological / adverse effects*
  • Antineoplastic Agents, Immunological / therapeutic use
  • Cell Cycle Checkpoints / immunology*
  • Granuloma / chemically induced*
  • Granuloma / pathology
  • Humans
  • Immunotherapy / adverse effects*
  • Immunotherapy / methods
  • Male
  • Mediastinal Diseases / chemically induced
  • Mediastinal Diseases / diagnosis
  • Mediastinal Diseases / pathology
  • Middle Aged
  • Neoplasms / pathology
  • Neoplasms / therapy*
  • Programmed Cell Death 1 Receptor / immunology
  • Sarcoidosis / chemically induced*
  • Sarcoidosis / pathology

Substances

  • Antibodies, Monoclonal
  • Antineoplastic Agents, Immunological
  • Programmed Cell Death 1 Receptor