Immune checkpoint inhibitor–associated sarcoidosis: A usually benign disease that does not require immunotherapy discontinuation
ICIR; Coordination; Co-Convenors; Steering committee; Research Fellows; Data Scientist
(2021) European Journal of Cancer, volume 158, pp. 208 - 216
(Article)
Abstract
Objective: To analyse the clinical patterns of sarcoidosis triggered by immune checkpoint inhibitors (ICIs) in patients with cancer. Patients and methods: The ImmunoCancer International Registry is a big data–sharing multidisciplinary network from 18 countries dedicated to evaluating the clinical research of immune-related adverse events related to cancer immunotherapies. Results: We
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identified 32 patients with biopsy-proven sarcoidosis. Underlying cancer included mainly melanoma (n = 24). Cancer immunotherapy consisted of monotherapy in 19 cases (anti-PD-1 in 18 and ipilimumab in 1) or combined ipilimumab + nivolumab in 13. The time median interval between initiation of ICI and sarcoidosis diagnosis was 3 months (range, 2–29 months). The use of combined ICI was associated with a shorter delay in developing sarcoidosis symptoms. The disease was symptomatic in 19 (59%) cases with mostly cutaneous, respiratory and general symptoms. The organs involved included mainly the mediastinal lymph nodes (n = 32), the lungs (n = 11), the skin (n = 10) and the eyes (n = 5). Pulmonary computed tomography studies showed bilateral hilar lymphadenopathy in all cases. There was no severe manifestation. Specific systemic therapy was required in only 12 patients (37%): oral glucocorticoids in 9, and hydroxychloroquine in 3. ICIs were held in 25 patients (78%) and definitively discontinued in 18 (56%) patients. Seven patients continued ICI treatment with a second flare in one case. In six additional patients, an ICI was reintroduced with no harm, and sarcoidosis relapsed in one of them. Conclusion: Our study shows that ICI-related sarcoidosis seems to have a specific profile, possibly more benign than that of idiopathic sarcoidosis, and does not necessarily imply ICI discontinuation.
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Keywords: Immune checkpoint inhibitor, Immune related adverse event, Immunotherapy, Readministration, Sarcoidosis, Oncology, Cancer Research
ISSN: 0959-8049
Publisher: Elsevier Limited
Note: Funding Information: Prof Olivier Lambotte was paid for expert testimony by and received consultancy fees from BMS France, MSD and Astra Zeneca; received consultancy fees from Incyte; gave expert testimony for Janssen and received grant from Gilead outside this work. Funding Information: Dr. Robert Baughman has received research grants from Genentech , Actelion , Bayer , aTyr , Belephron , Mallinckrodt and Novartis . He has been a consultant for Riovant, Mallinckrodt and United Therapeutics. He is a member of the speakers’ bureau for Mallinckrodt, Boehringer Ingelheim and United Therapeutics. Funding Information: Dr. Robert Baughman has received research grants from Genentech, Actelion, Bayer, aTyr, Belephron, Mallinckrodt and Novartis. He has been a consultant for Riovant, Mallinckrodt and United Therapeutics. He is a member of the speakers? bureau for Mallinckrodt, Boehringer Ingelheim and United Therapeutics.Karolina Benesova has received research grant/research support from (any project) Medical faculty (Olympia Morata Programme) and Foundations commission of University of Heidelberg, Rheumaliga Baden-W?rttemberg e.V., Abbvie Novartis. She received consultancy and/or speaker fees and/or travel reimbursements (any project) from Abbvie, BMS, Gilead/Galapagos, Janssen, Lilly, MSD, Medac, Mundipharma, Novartis, Pfizer, Roche, and UCB.F?d?ration Hospitalo-Universitaire CARE (Cancer and Autoimmunity Relationships), APHP, Universit? Paris Saclay. Publisher Copyright: © 2021 Elsevier Ltd
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