Current PerspectiveDrug-induced sarcoidosis-like reaction in adjuvant immunotherapy: Increased rate and mimicker of metastasis
Section snippets
Background
Immune checkpoint inhibitors (ICIs) and kinase inhibitors have become the standard-of-care treatments for patients with advanced melanoma [1]. Recently, anti-[programmed cell death protein 1 (PD-1)] antibodies nivolumab and pembrolizumab as well as [proto-oncogene B-Raf (BRAF)]-inhibitor dabrafenib plus [mitogen-activated protein kinase kinase enzyme (MEK)]-inhibitor trametinib have been approved for the adjuvant treatment of patients with high-risk melanoma [[2], [3], [4]].
Sarcoidosis is a
Discussion and conclusions
As the exact pathophysiology of sarcoidosis itself is still unknown, it can only be speculated whether ICIs are inducing a DISR syndrome very similar to sarcoidosis or are truly inducing sarcoidosis [6]. The temporal relationship with initiation of ICI treatment as well as the improvement after ICI treatment discontinuation as described in our patients speak for DISR.
Sarcoidosis-like reactions/sarcoidosis induced by ICI has been reported for both anti-CTLA4-and anti-PD1-blocking agents [8,12].
Ethics approval and consent to participate
Not applicable.
Consent for publication
Is available on request.
Availability of data and materials
The datasets used and/or analysed during the current study are available from the corresponding author on reasonable request.
Funding
This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sector.
Authors' contributions
EC, TK, DS and EL analyzed and interpreted the patient data and were a major contributor in writing the manuscript. Eva Hadaschik and Dirk Theegarten performed the histological examinations, Eva Hadaschik further performed the PD-L1 staining of the tumour- and SLR-material. All authors read, gave their recommendations and approved the final manuscript.
Conflict of interest statement
E.C.: reports travel support from Bristol-Myers Squibb, MSD SHARP & DOHME and Novartis.T.K.: reports travel support from Novartis, Amgen, Celgene, Lilly and Pierre-Fabre.
L.Z.: served as consultant and/or has received honoraria from Roche, Bristol-Myers Squibb (BMS), Merck Sharp & Dohme (MSD), Novartis, Pierre Fabre, Sanofi, and travel support from MSD, BMS, Amgen, Pierre Fabre and Novartis.
E.H.: reports no conflict of interest.
S.U.: reports grants, personal fees and non-financial support from
Acknowledgements
The authors are indebted to all patients and their relatives and would like to thank Antje Sucker and Julia Kretz from the Dept. of Dermatology, University Hospital Essen, for the laboratory assistance including PD-L1 staining.
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