Chest
Selected ReportsNivolumab-Induced Sarcoid-Like Granulomatous Reaction in a Patient With Advanced Melanoma
Section snippets
Case Report
A 57-year-old patient was diagnosed in 2011 with an invasive desmoplastic melanoma of the right nasolabial fold (Breslow thickness, 4.0 mm; Clark level, 5), for which he underwent wide local resection.
In May 2013, he developed an unresectable relapse involving on the right nasolabial fold. MRI showed a 27 × 43 mm necrotic tumor, expanding to the outer canthus, lower eyelid region, and lacrimal sac, with a deep extension to the nasal cavity. Whole-body tomodensitometry and cerebral MRI did not
Discussion
To our knowledge, this is the first report of nivolumab-induced sarcoid-like granulomatous reaction. Nivolumab improves overall survival of patients with advanced melanoma in first-line treatment in BRAF wild-type melanoma patients.1 Nivolumab is a fully human IgG4 anti-PD-1 immune checkpoint inhibitor antibody that selectively blocks the interaction of the PD-1 receptor with its two known programmed death ligands, PD-L1 and PD-L2, disrupting the negative signal that regulates T-cell activation
Conclusion
Cutaneous, lymph node, or pulmonary lesion during immunotherapy is not always related to disease progression, but sometimes to sarcoid-like granulomatous reaction. Further studies should aim to investigate predisposing factors for immunotherapy-induced sarcoid-like granulomatous reaction and the impact on melanoma progression.
Acknowledgments
Author contributions: F.-X. D., C. P., B. B., M. M., A. T., and C. L. undertook the concept and design; F.-X. D., C. P., L. V., M. Battistella, A. T., and C. L. undertook analysis and interpretation; and C. P., M. Battistella, M. Bagot, A. T., and C. L. undertook drafting the manuscript for important intellectual content.
Financial/nonfinancial disclosures: C. P. and C. L. has participated to advisory boards for BMS. None declared (F.-X. D., C. P., B. B., L. V., M. Battistella, M. M., M. J., M.
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Granulomatous reaction induced by nivolumab. A case report
2023, Revista Espanola de Medicina Nuclear e Imagen MolecularRetrospective study of the incidence of sarcoidosis-like reaction in patients treated with immunotherapy
2023, Clinical RadiologyCitation Excerpt :This patient had persistent hypermetabolic mediastinal and bilateral hilar lymphadenopathy as well as diffuse skin and breast lesions 13 months after first imaging manifestation of sarcoidosis, suggesting that pre-existing sarcoidosis may predispose the patient to prolonged duration of this adverse event. Danlos et al. reviewed nine case reports of sarcoid-like reaction induced by ipilimumab after treating metastatic melanoma and found that 44% (4/9) patients received corticosteroid treatment with subsequently regression of sarcoidosis-like reaction.8 Chorti et al. reported that most patients were asymptomatic and thus no treatment was required in their study.22