Sarcoidosis-Like Granulomatous Reaction Associated With Pembrolizumab Immunotherapy.
Sarcoidosis-Like Granulomatous Reaction Associated With Pembrolizumab Immunotherapy. Arch Bronconeumol. 2018 May 22;: Authors: Gayá García-Manso I, García Ródenas MDM, Barroso Medel ME, Illán Gambín FJ PMID: 29801680 [PubMed - as supplied by publisher]
ConclusionBased on our findings, 10% patients in the interim or late PET/CT showed ‘sarcoid-like lymphadenopathy’ as response to treatment. All these patients showed disease control, implying a relation between the appearance of sarcoid-like lymphadenopathy and the clinical benefit of anti-CTLA-4 therapy. On the other hand, quantitative18F-FDG PET analysis of the spleen showed a poor performance in predicting clinical benefit to ipilimumab.
Immunotherapy,Volume 10, Issue 14, Page 1189-1192, October 2018.
CONCLUSIONS: Knowledge of this toxicity is crucial as the clinical signs and radiological patterns may suggest tumour progression. PMID: 30220489 [PubMed - as supplied by publisher]
Abstract: A hospital-based cross-sectional study was performed, including 117 psoriatic patients and 117 controls matched for age, gender, and body mass index. Psoriatic patients had higher levels of serum uric acid (6.25 ± 1.62 vs 5.71 ± 1.35 mg/dl; P=0.019) and significantly greater prevalence of hyperuricemia (31.6% vs 16.2%; P=0.009) than individuals without psoriasis. Psoriatic patients had significantly higher serum uric acid than controls in subjects without metabolic syndrome. Multivariate logistic regressi on analysis showed that psoriasis can be a strong predictor of hyperuricemia (odds ratio 2.61; ...
A 49-year-old woman had sudden visual loss in her left eye associated with retrobulbar pain and decrease in visual evoked potential amplitude. With suspected optic neuritis, the patient was treated successfully with a 5-day therapy of methylprednisolone (MP) infusion of 1 g per day (figure 1A). Within several days after MP, partial visual loss reoccurred. MRI showed increased signal and contrast enhancement of the left optic nerve (figure 1, B and C); further diagnostic workup including cerebral and spinal MRI and CSF analysis with oligoclonal bands and soluble Il-2 receptor was normal. Serum antibody screening for aq...
Granulomatous reactions are an immune related adverse event of immune checkpoint inhibitors. Sarcoidosis-like reactions can be misdiagnosed as metastatic disease progression and do not appear to be associated with favorable tumor response. Cutaneous findings can facilitate timely and accurate diagnosis, avoiding unnecessary immunotherapy modifications.
ConclusionsImmune-related adverse effects often occur within 3 –6 months of receiving immune checkpoint inhibitor therapy, with some reports of late toxicity. This report highlights a case of probable neurosarcoidosis nearly a year after discontinuation of immune checkpoint therapy. The potential for durable responses after discontinuation of therapy also li kely underscores a potential for late toxicity. In patients presenting with new or unexplained symptoms after checkpoint inhibitor therapy, the index of suspicion for an immune-related adverse effect should remain high, irrespective of timing.
We report a case of sarcoid-like granulomatous tumoral melanosis in a patient on the programmed cell death-1 (PD-1) receptor inhibitor pembrolizumab for metastatic melanoma. This is, to our knowledge, the first reported case of a sarcoidal form of tumoral melanosis in a patient on anti-PD-1 therapy. We postulate that this reflects tumor regression in response to pembrolizumab-induced immune activation, with concomitant therapy–triggered induction of a sarcoid-like reaction. These findings and the literature review presented herein should alert clinicians and pathologists to the possibility of regressed lesions with s...
ConclusionThis case sheds the light on a complex regulation of PD-L1 expression in vivo on PBMC after nivolumab arrest and triggers the question of monitoring the expression of immune checkpoint on immune cells during and after treatment with ICI.
Conclusions: To avoid pitfall in PET/CT interpretation, it is important to recognize the sarcoid-like pattern of FDG uptake, which regardless of SUV value is favored to represent a benign rather than a malignant process.