1
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Shrateh ON, Abugharbieh Y, Asbeh YA, Hour H, Awad I, Bannoura S. Sarcoid-like reaction and hypothyroidism induced by PD-1 inhibitor treatment in metastatic renal cell carcinoma: a case report and literature review. BMC Pulm Med 2024; 24:123. [PMID: 38459507 PMCID: PMC10924379 DOI: 10.1186/s12890-024-02943-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2023] [Accepted: 03/01/2024] [Indexed: 03/10/2024] Open
Abstract
BACKGROUND Pembrolizumab is among the approved treatments for a variety of cancer types, including clear cell renal cell carcinoma (ccRCC). It has contributed to enhancing the prognosis of renal cell carcinoma. However, it is essential to be aware of the numerous potential immune-related side effects associated with its use. CASE PRESENTATION A 69-year-old patient with a history of metastatic renal cell carcinoma has been undergoing treatment with Pembrolizumab, an immune checkpoint inhibitor. The medication has led to the development of a sarcoid-like reaction, initially misinterpreted as cancer recurrence and progression. Additionally, the patient has experienced new-onset hypothyroidism, which has been attributed to the immunotherapy. CONCLUSION Clinicians, including oncologists, endocrinologists, and radiologists, should maintain a high level of suspicions and awareness regarding the potential adverse events associated with newly introduced immunotherapies like pembrolizumab. This knowledge is crucial for the accurate diagnosis and appropriate management of patients receiving these treatments.
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Affiliation(s)
- Oadi N Shrateh
- Faculty of Medicine, Al-Quds University, Jerusalem, Palestine.
| | | | - Yousef Abu Asbeh
- Department of Thoracic Surgery, Al-Ahli Hospital, Hebron, Palestine
| | - Hani Hour
- Department of Oncology, Al-Ahli Hospital, Hebron, Palestine
| | - Iyad Awad
- Deparment of Radiology, Al-Ahli Hospital, Hebron, Palestine
| | - Sami Bannoura
- Department of Pathology, Al-Ahli Hospital, Hebron, Palestine
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2
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Ahsan M, Ashkin A, Lindner DH, Patel VP, Lipman A. Sarcoid-like reaction in malignant melanoma exacerbated with pembrolizumab therapy case report. Heliyon 2024; 10:e24375. [PMID: 38304765 PMCID: PMC10830524 DOI: 10.1016/j.heliyon.2024.e24375] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2023] [Revised: 12/24/2023] [Accepted: 01/08/2024] [Indexed: 02/03/2024] Open
Abstract
Sarcoid Like Reaction (SLR) is a localized non-caseating epithelioid granulomatous reaction seen secondary to certain immunotherapies and malignancies. Invasive melanoma, while being associated with onset of sarcoidosis, has not shown to directly induce SLR in the literature. We present the case of a 68-year-old male with malignant melanoma, who was found to have SLR prior to starting immunotherapy, which worsened while on pembrolizumab. This case highlights the challenge of distinguishing between drug-induced SLR and melanoma-induced SLR, and the implications in terms of management.
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Affiliation(s)
- Mohammed Ahsan
- Naples Community Hospital, 311 9th St. N. Suite 300, Naples, FL, 34102-5804, USA
| | - Alex Ashkin
- Naples Community Hospital, 311 9th St. N. Suite 300, Naples, FL, 34102-5804, USA
| | - David H. Lindner
- Naples Community Hospital, 311 9th St N #304, Naples, FL 34102 Naples, FL, 34102-5804, USA
- Instructor Mayo Clinic College of Medicine and Science
- Associate Professor of Medicine University Central Florida
- Adjunct Professor of Medicine NOVA Southeastern
- Medical Director NCH Healthcare Intensive Care Units and Respiratory Care
- Associate Pulmonary Program Director NCH Healthcare System
| | - Vishal P. Patel
- Naples Community Hospital, 1285 Creekside Blvd E, Naples, FL, 34109, USA
| | - Andrew Lipman
- Medical Oncology and Hematology, Florida Cancer Specialists & Research Institute, Naples West: 681 4th Avenue N, Naples, FL, 34102, USA
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3
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Eljilany I, Noor A, Paravathaneni M, Yassine I, Lee SJ, Othus M, Moon J, Kirkwood JM, Sondak VK, Ribas A, Grossmann KF, Tarhini AA. Granulomatous and Sarcoid-like Immune-Related Adverse Events following CTLA4 and PD1 Blockade Adjuvant Therapy of Melanoma: A Combined Analysis of ECOG-ACRIN E1609 and SWOG S1404 Phase III Trials and a Literature Review. Cancers (Basel) 2023; 15:2561. [PMID: 37174027 PMCID: PMC10177189 DOI: 10.3390/cancers15092561] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Revised: 04/26/2023] [Accepted: 04/27/2023] [Indexed: 05/15/2023] Open
Abstract
BACKGROUND Treatment with immune checkpoint inhibitors (ICIs) has been linked to granulomatous and sarcoid-like lesions (GSLs) affecting different organs. This study sought to evaluate GSL incidence in patients with high-risk melanoma treated with cytotoxic T-lymphocyte antigen 4 (CTLA4) or programmed cell death 1 (PD1) blockade adjuvant therapy in two clinical trials: ECOG-ACRIN E1609 and SWOG S1404. Descriptions and GSL severity ratings were recorded. METHODS Data were collected from ECOG-ACRIN E1609 and SWOG S1404. Descriptive statistics along with GSL severity grades were reported. Additionally, a literature review for such cases was summarized. RESULTS A total of 11 GSL cases were reported among 2878 patients treated with either ICI or with High-Dose Interferon Alfa-2b (HDI) in ECOG-ACRIN E1609 and SWOG S1404 trials. Cases were numerically more commonly reported with ipi10, followed by pembrolizumab, ipi3, and HDI, respectively. Most of the cases were grade III. Further, organs involved included lung, mediastinal lymph nodes, skin and subcutaneous tissue, and eye. Furthermore, a summary of 62 reports in the literature was described. CONCLUSIONS GSLs following anti-CTLA4 and anti-PD1 antibody therapy in patients with melanoma were reported unusually. Reported cases ranged in grade from I to III and appeared manageable. Careful attention to these events and their reporting will be essential to better guide practice and management guidelines.
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Affiliation(s)
- Islam Eljilany
- Houston Lee Moffitt Cancer Center and Research Institute, Tampa, FL 33612, USA
| | - Arish Noor
- Houston Lee Moffitt Cancer Center and Research Institute, Tampa, FL 33612, USA
| | | | - Ibrahim Yassine
- Houston Lee Moffitt Cancer Center and Research Institute, Tampa, FL 33612, USA
- Department of Psychology, College of Life Sciences, University of California, Los Angeles, CA 90095, USA
| | - Sandra J. Lee
- Dana Farber Cancer Institute, Harvard Medical School, Boston, MA 02215, USA
| | - Megan Othus
- Fred Hutchinson Cancer Research Center, Seattle, WA 98109, USA
| | - James Moon
- Fred Hutchinson Cancer Research Center, Seattle, WA 98109, USA
| | - John M. Kirkwood
- UPMC Hillman Cancer Center, University of Pittsburgh, Pittsburgh, PA 15213, USA
| | - Vernon K. Sondak
- Houston Lee Moffitt Cancer Center and Research Institute, Tampa, FL 33612, USA
| | - Antoni Ribas
- Department of Psychology, College of Life Sciences, University of California, Los Angeles, CA 90095, USA
| | | | - Ahmad A. Tarhini
- Houston Lee Moffitt Cancer Center and Research Institute, Tampa, FL 33612, USA
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4
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Purcell V, Preti B, Fernandes R. Suspected immune checkpoint inhibitor-induced pulmonary sarcoid reaction in metastatic renal cell carcinoma. Clin Case Rep 2022; 10:e5960. [PMID: 35846932 PMCID: PMC9272222 DOI: 10.1002/ccr3.5960] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Revised: 05/19/2022] [Accepted: 05/30/2022] [Indexed: 01/09/2023] Open
Abstract
We present the case of a 50-year-old male patient with metastatic clear cell renal cell carcinoma (mRCC) who developed a diffuse pulmonary opacification and lymphadenopathy during nivolumab maintenance therapy. This was diagnosed as presumed sarcoid granulomatous inflammatory reaction secondary to immunotherapy, which resolved with holding off therapy and the nivolumab was resumed.
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Affiliation(s)
- Victoria Purcell
- Schulich School of Medicine and DentistryWestern UniversityLondonOntarioCanada
| | - Beatrice Preti
- Schulich School of Medicine and DentistryWestern UniversityLondonOntarioCanada,Division of Medical Oncology, Department of Oncology, Schulich School of Medicine & DentistryWestern UniversityLondonOntarioCanada
| | - Ricardo Fernandes
- Schulich School of Medicine and DentistryWestern UniversityLondonOntarioCanada,Division of Medical Oncology, Department of Oncology, Schulich School of Medicine & DentistryWestern UniversityLondonOntarioCanada,Cancer Research Laboratory ProgramLawson Health Research InstituteLondonOntarioCanada
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5
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Immunotherapy pitfall: sarcoid-like reaction mimicking disease progression in advanced melanoma treated with nivolumab. MEMO - MAGAZINE OF EUROPEAN MEDICAL ONCOLOGY 2022. [DOI: 10.1007/s12254-022-00806-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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6
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Lin Y, Zhu W, Wu B, Lan H. Case Report: Hepatic Sarcoid-Like Reaction Associated With Checkpoint Inhibition in a NSCLC Patient and a Literature Review. Front Oncol 2022; 12:824308. [PMID: 35359368 PMCID: PMC8960956 DOI: 10.3389/fonc.2022.824308] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Accepted: 02/15/2022] [Indexed: 12/24/2022] Open
Abstract
Immune checkpoint inhibitor (ICI) treatment has dramatically revolutionized the landscape of therapeutic approaches in multiple cancers, particularly, non-small-cell lung cancer (NSCLC). With the increasing use of programmed death-1 (PD-1) inhibitors in the clinic, the emerging toxicity profile presents a novel learning curve for clinicians. Here we report the first case of an NSCLC patient displaying sarcoid/granulomatous-like reaction (SLR, also known as GLR) in the liver during an anti-PD-1 therapy which showed efficacious response of complete regression. Also, this is the first report describing the SLR induced by toripalimab, a novel PD-1 inhibitor. Given this kind of hepatic findings can be easily mistaken as metastasis, even resulting in premature use of second-line treatments. In particular, we briefly review the clinical features of all those cases reporting sarcoidosis and SLRs manifested on different organs during anti-PD-(L)1 therapy. We anticipate that these clinical cases would help to alert the attention of clinicians that SLRs, as a rare immune-related adverse event (irAE), is manageable and that histopathological analysis is necessary before interpreting it as disease progression.
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Affiliation(s)
- Yuxin Lin
- Department of Oncology, Hospital of Chinese Medicine of Changxing County, Huzhou, China
| | - Wei Zhu
- Department of Oncology, Hospital of Chinese Medicine of Changxing County, Huzhou, China
| | - Bingchen Wu
- Department of Oncology, Hospital of Chinese Medicine of Changxing County, Huzhou, China
| | - Huiyin Lan
- Department of Thoracic Radiation Oncology, Cancer Hospital of the University of Chinese Academy of Sciences (Zhejiang Cancer Hospital), Hangzhou, China.,Institute of Cancer and Basic Medicine, Chinese Academy of Sciences, Hangzhou, China
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7
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Iyalomhe O, Farwell MD. Immune PET Imaging. Radiol Clin North Am 2021; 59:875-886. [PMID: 34392924 PMCID: PMC8371717 DOI: 10.1016/j.rcl.2021.05.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Fluorodeoxyglucose (FDG) PET/CT is sensitive to metabolic, immune-related, and structural changes that can occur in tumors in cancer immunotherapy. Unique mechanisms of immune checkpoint inhibitors (ICIs) occasionally make response evaluation challenging, because tumors and inflammatory changes are both FDG avid. These response patterns and sequelae of ICI immunotherapy, such as immune-related adverse events, are discussed. Immune-specific PET imaging probes at preclinical stage or in early clinical trials, which may help guide clinical management of cancer patients treated with immunotherapy and likely have applications outside of oncology for other diseases in which the immune system plays a role, are reviewed.
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Affiliation(s)
- Osigbemhe Iyalomhe
- Department of Radiology, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Michael D. Farwell
- Department of Radiology, University of Pennsylvania, Philadelphia, PA 19104, USA
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8
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Schierz JH, Sarikaya I, Wollina U, Unger L, Sarikaya A. Immune checkpoint inhibitor related adverse effects and FDG PET/CT findings. J Nucl Med Technol 2021; 49:324-329. [PMID: 34330805 DOI: 10.2967/jnmt.121.262151] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2021] [Revised: 05/20/2021] [Indexed: 11/16/2022] Open
Abstract
Immune check-point inhibitor (ICI) treatments activate the T-cells against tumor. Activated T-cells not only attack the tumor but also healthy cells, causing an autoimmune reaction in various tissues. These immune related adverse effects (IRAE) cause 18F-fluorodeoxyglucose (FDG) uptake in various tissues due to inflammation. It is important to recognize and report these findings on FDG Positron Emission Tomography/Computed Tomography (PET/CT) studies. FDG PET helps to determine the presence, location and severity of IRAEs. In severe cases, ICI treatments are interrupted or suspended and anti-inflammatory treatments are started. FDG uptake due IRAEs may mimic metastases or disease progression. Their presence may also help predicting response to treatment and have prognostic implications. In this review article, we will provide basic information about ICI treatments, IRAEs and FDG PET/CT findings.
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Affiliation(s)
| | - Ismet Sarikaya
- Kuwait University Faculty of Medicine, Department of Nuclear Medicine, Kuwait, Kuwait
| | - Uwe Wollina
- Municipal Hospital Dresden, Department of Dermatology, Dresden, Germany
| | - Leonore Unger
- Municipal Hospital Dresden, Department of Rheumatology, Dresden, Germany
| | - Ali Sarikaya
- Trakya university Faculty of Medicine, Department of Nuclear Medicine, Turkey
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9
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Sarcoid-Like Reaction in Non-Hodgkin's Lymphoma-A Diagnostic Challenge for Deauville Scoring on 18F-FDG PET/CT Imaging. Diagnostics (Basel) 2021; 11:diagnostics11061009. [PMID: 34073137 PMCID: PMC8229233 DOI: 10.3390/diagnostics11061009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2021] [Revised: 05/26/2021] [Accepted: 05/28/2021] [Indexed: 11/16/2022] Open
Abstract
The sarcoid-like reaction represents an autoinflammatory cause of mediastinal and hilar lymphadenopathy but may also involve other lymph node regions and organs. This rare phenomenon has mainly been reported in patients with Hodgkin’s lymphoma (HL) or solid tumors (particularly melanoma) undergoing immunotherapy and chemotherapy. Cases in non-Hodgkin’s lymphoma (NHL) are very uncommon. We present an uncommon case of a patient with primarily mediastinal diffuse large B-cell lymphoma (DLBCL) who showed a CT-based partial response in interim staging, whereas at end-of-treatment multiple newly enlarged and hypermetabolic mediastinal and bilateral hilar lymph nodes were detected by 18F-FDG PET/CT imaging. A subsequent histological workup determined a sarcoid-like reaction without any lymphomatous tissue. Therefore, sarcoid-like reactions should be considered as a potential pitfall in Deauville staging with 18F-FDG PET/CT imaging for patients with NHL.
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10
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Khalid T, Patil A, Ahmed A, Yousif A. Sarcoid-like reaction: a unique response to immunotherapy in malignant melanoma. BMJ Case Rep 2021; 14:14/5/e243723. [PMID: 34049896 DOI: 10.1136/bcr-2021-243723] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
In recent years, immunotherapy has revolutionised the treatment landscape for oncology patients with improved survival rates in cancers which previously had a dismissal prognosis. These agents target specific pathways of inhibition such as programmed cell death -1 (PD-1), PD ligand-1 and cytotoxic T-lymphocyte-associated antigen 4 resulting in stimulation of T cell activity. This results in enabling an individual's own immune system to fight against cancer, a different modality of treatment when compared with traditional chemotherapy. While attacking the tumour cells, there is an increased chance of host tissue immune reactions.We report a case of a patient who received immunotherapy for metastatic malignant melanoma. During the course of the treatment, development of a sarcoid-like reaction was histologically confirmed in the mediastinal lymph nodes. The patient had no respiratory symptoms and continued on the immunotherapy treatment with good clinical and radiological response.
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Affiliation(s)
- Taha Khalid
- Oncology, Sligo University Hospital, Sligo, Ireland
| | - Asma Patil
- Oncology, Sligo University Hospital, Sligo, Ireland
| | - Alina Ahmed
- Medicine, Kingsbridge Private Hospital, Sligo, Ireland
| | - Ala Yousif
- Oncology, Sligo University Hospital, Sligo, Ireland
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11
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Ferdinandus J, Metzenmacher M, Kessler L, Umutlu L, Aigner C, Karl KO, Grünwald V, Eberhardt W, Fendler WP, Herrmann K, Faehling M, Christoph DC. Complete metabolic response in patients with advanced nonsmall cell lung cancer with prolonged response to immune checkpoint inhibitor therapy. J Immunother Cancer 2021; 9:jitc-2020-002262. [PMID: 33789880 PMCID: PMC8016096 DOI: 10.1136/jitc-2020-002262] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/17/2021] [Indexed: 12/26/2022] Open
Abstract
Introduction Immunotherapy is the new standard of care in advanced non-small cell lung cancer (NSCLC). Recently published data show that treatment discontinuation after 12 months of nivolumab treatment is associated with shorter survival. Therefore, the ideal duration of immunotherapy remains unclear, and finding markers of beneficial outcomes is of great importance. Here, we determine the proportion of complete metabolic responses (CMR) in patients who have not progressed after 24 months of immunotherapy. Methods This is a retrospective analysis of 45 patients with positron emission tomography using 2-[18F]fluoro-2-deoxy-D-glucose imaging for assessment of residual metabolic activity after at least 24 months. CMR was defined as uptake in tumor lesions below background levels, using mediastinum as a reference. Results Out of 45 patients, 29 patients had a CMR (64%). CMR was observed more frequently in non-first-line patients. Patients with CMR were younger (median 65.7 vs 75.5, p=0.03). Fourteen patients with CMR have discontinued therapy and have not progressed until time of analysis; however, median follow-up was only 5.6 (range 0.8–17.0) months. Conclusion After a minimum of 24 months of palliative immunotherapy for NSCLC, CMR occurred in almost two thirds of patients. Potentially, achievement of CMR might identify patients, for whom palliative immunotherapy may be safely discontinued.
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Affiliation(s)
- Justin Ferdinandus
- Department of Nuclear Medicine, University Hospital Essen, Essen, Nordrhein-Westfalen, Germany
| | | | - Lukas Kessler
- Department of Nuclear Medicine, University Hospital Essen, Essen, Nordrhein-Westfalen, Germany
| | - Lale Umutlu
- Department of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, Essen, Nordrhein-Westfalen, Germany
| | - Clemens Aigner
- Department of Thoracic Surgery, University Hospital Essen, Essen, Nordrhein-Westfalen, Germany
| | | | - Viktor Grünwald
- Interdisciplinary GU Oncology, University Hospital Essen, Essen, Germany
| | - Wilfried Eberhardt
- Medical Oncology, University Hospital Essen, Essen, Nordrhein-Westfalen, Germany
| | - Wolfgang Peter Fendler
- Department of Nuclear Medicine, University Hospital Essen, Essen, Nordrhein-Westfalen, Germany
| | - Ken Herrmann
- Department of Nuclear Medicine, University Hospital Essen, Essen, Nordrhein-Westfalen, Germany
| | - Martin Faehling
- Department of Cardiology and Pneumology, Hospital Esslingen, Esslingen, Baden-Württemberg, Germany
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12
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Anderson MA, Kurra V, Bradley W, Kilcoyne A, Mojtahed A, Lee SI. Abdominal immune-related adverse events: detection on ultrasonography, CT, MRI and 18F-Fluorodeoxyglucose positron emission tomography. Br J Radiol 2021; 94:20200663. [PMID: 33112648 DOI: 10.1259/bjr.20200663] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Immune checkpoint inhibitor and chimeric antigen receptor T-cell therapies are associated with a unique spectrum of complications termed immune-related adverse events (irAEs). The abdomen is the most frequent site of severe irAEs that require hospitalization with life-threatening consequences. Most abdominal irAEs such as enterocolitis, hepatitis, cholangiopathy, cholecystitis, pancreatitis, adrenalitis, and sarcoid-like reaction are initially detected on imaging such as ultrasonography (US), CT, MRI and fusion 18F-fluorodeoxyglucose (FDG) positron emission tomography (PET)-CT during routine surveillance of cancer therapy. Early recognition and diagnosis of irAEs and immediate management with cessation of immune modulator cancer therapy and institution of immunosuppressive therapy are necessary to avert morbidity and mortality. Diagnosis of irAEs is confirmed by tissue sampling or by follow-up imaging demonstrating resolution. Abdominal radiologists reviewing imaging on patients being treated with anti-cancer immunomodulators should be familiar with the imaging manifestations of irAEs.
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Affiliation(s)
- Mark A Anderson
- Department of Radiology, Massachusetts General Hospital, Boston, MA, USA.,Department of Radiology, Harvard Medical School, Boston, MA, USA
| | - Vikram Kurra
- Department of Radiology, Massachusetts General Hospital, Boston, MA, USA.,Department of Radiology, Harvard Medical School, Boston, MA, USA
| | - William Bradley
- Department of Radiology, Massachusetts General Hospital, Boston, MA, USA.,Department of Radiology, Harvard Medical School, Boston, MA, USA
| | - Aoife Kilcoyne
- Department of Radiology, Massachusetts General Hospital, Boston, MA, USA.,Department of Radiology, Harvard Medical School, Boston, MA, USA
| | - Amirkasra Mojtahed
- Department of Radiology, Massachusetts General Hospital, Boston, MA, USA.,Department of Radiology, Harvard Medical School, Boston, MA, USA
| | - Susanna I Lee
- Department of Radiology, Massachusetts General Hospital, Boston, MA, USA.,Department of Radiology, Harvard Medical School, Boston, MA, USA
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13
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Kang HJ, Kim Y, Bae JY, Chang JH, Lee SH. Sarcoid-Like Reaction after Complete Remission of Malignancy: CT and 18F-FDG PET/CT Features for the Differential Diagnosis from Lymph Node Metastasis. JOURNAL OF THE KOREAN SOCIETY OF RADIOLOGY 2021; 82:903-913. [PMID: 36238067 PMCID: PMC9514401 DOI: 10.3348/jksr.2020.0091] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Revised: 08/15/2020] [Accepted: 09/15/2020] [Indexed: 11/15/2022]
Abstract
Purpose Materials and Methods Results Conclusion
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Affiliation(s)
- Hyun Ji Kang
- Department of Radiology, College of Medicine, Ewha Womans University, Seoul, Korea
| | - Yookyung Kim
- Department of Radiology, College of Medicine, Ewha Womans University, Seoul, Korea
| | - June Young Bae
- Department of Radiology, College of Medicine, Ewha Womans University, Seoul, Korea
| | - Jung Hyun Chang
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, College of Medicine, Ewha Womans University, Seoul, Korea
| | - Soo-Hyun Lee
- Department of Radiology, National Cancer Center, Goyang, Korea
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14
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Yousuf H, Mekki R, Khan K, Hussain A. Pembrolizumab-Induced Sarcoid-Like Reaction in a Patient With Lung Cancer. Cureus 2020; 12:e12395. [PMID: 33409108 PMCID: PMC7779128 DOI: 10.7759/cureus.12395] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/31/2020] [Indexed: 11/23/2022] Open
Abstract
Cancer is not only the leading cause of mortality and morbidity but also poses a major economic burden. Until recently, onco-immunotherapy has dramatically changed the landscape of cancer treatment. For example, an inhibitor of programmed cell death (PD-1) plays a vital role by potentiating effective immune-mediated destruction of tumor cells. However, the spectrum of immune-related adverse events especially granulomatous sarcoid lesions has been recognized too. Such lesions involve the dermis and subcutaneous tissue (panniculitis) and lymph nodes. Herein we are presenting a case report of a patient, who developed a sarcoid-like reaction after treatment with pembrolizumab.
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Affiliation(s)
- Hira Yousuf
- Oncology, Pinderfields General Hospital, Wakefield, GBR
| | - Rasheid Mekki
- Medical Oncology, Pinderfields General Hospital, Wakefield, GBR
| | - Khizer Khan
- Respiratory Medicine, Pinderfields Hospital, Wakefield, GBR
| | - Ali Hussain
- Acute Medicine, Pinderfields General Hospital, Wakefield, GBR
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15
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Cardiothoracic Complications of Immune Checkpoint Inhibitor Therapy: An Imaging Review. J Comput Assist Tomogr 2020; 44:652-655. [PMID: 32842069 DOI: 10.1097/rct.0000000000001068] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
Immune checkpoint inhibitor therapy has revolutionized the treatment of many different types of cancer. However, despite dramatic improvements in tumor oncologic response and patient outcomes, immune checkpoint blockade has been associated with multiple distinctive side-effects termed immune-related adverse events. These often have important clinical implications because these can vary in severity, sometimes even resulting in death. Therefore, it is important for both radiologists and clinicians to recognize and be aware of these reactions to help appropriately guide patient management. This article specifically highlights imaging manifestations of the most common cardiothoracic toxicities of these agents, including pneumonitis, sarcoid-like granulomatosis and lymphadenopathy, and myocarditis.
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16
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Pourvaziri A, Parakh A, Biondetti P, Sahani D, Kambadakone A. Abdominal CT manifestations of adverse events to immunotherapy: a primer for radiologists. Abdom Radiol (NY) 2020; 45:2624-2636. [PMID: 32451672 DOI: 10.1007/s00261-020-02531-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Immunotherapy is a rapidly growing field within oncology and is being increasingly used in the management of several malignancies. Due to their unique mechanism of action on the immune system and neoplastic cells, the response pattern and adverse events of this novel therapy are distinct from conventional systemic therapies. Accordingly, the imaging appearances following immunotherapy including adverse events are unique and at times perplexing. Imaging is integral to management of patients on immunotherapeutic agents and a thorough understanding of its mechanism, response patterns and adverse events is crucial for precise interpretation of imaging studies. This review provides a description of the mechanism of action of current immunotherapeutic agents and the organ-wise description of their side effects.
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Affiliation(s)
- Ali Pourvaziri
- Division of Abdominal Imaging, Massachusetts General Hospital, Harvard Medical School, 55 Fruit St, White 270, Boston, MA, 02114, USA
| | - Anushri Parakh
- Division of Abdominal Imaging, Massachusetts General Hospital, Harvard Medical School, 55 Fruit St, White 270, Boston, MA, 02114, USA
| | - Pierpaolo Biondetti
- Division of Abdominal Imaging, Massachusetts General Hospital, Harvard Medical School, 55 Fruit St, White 270, Boston, MA, 02114, USA
| | - Dushyant Sahani
- Department of Radiology, University of Washington, UWMC Radiology RR218, 1959 NE Pacific St, Seattle, WA, 98195, USA
| | - Avinash Kambadakone
- Division of Abdominal Imaging, Massachusetts General Hospital, Harvard Medical School, 55 Fruit St, White 270, Boston, MA, 02114, USA.
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Intrathoracic Manifestations of Sarcoidosis: an Imaging Review Highlighting Atypical Features. CURRENT PULMONOLOGY REPORTS 2020. [DOI: 10.1007/s13665-020-00255-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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18
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Rubio-Rivas M, Moreira C, Marcoval J. Sarcoidosis related to checkpoint and BRAF/MEK inhibitors in melanoma. Autoimmun Rev 2020; 19:102587. [DOI: 10.1016/j.autrev.2020.102587] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2020] [Accepted: 02/01/2020] [Indexed: 12/11/2022]
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19
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Gebrekidan S, Schaller T, Rank A, Kircher M, Lapa C. Sarcoid-like reactions: a potential pitfall in oncologic imaging. Eur J Nucl Med Mol Imaging 2020; 48:931-932. [PMID: 32710223 PMCID: PMC8036196 DOI: 10.1007/s00259-020-04960-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Accepted: 07/13/2020] [Indexed: 11/11/2022]
Affiliation(s)
| | - Tina Schaller
- General Pathology and Molecular Diagnostics, Medical Faculty, University of Augsburg, Augsburg, Germany
| | - Andreas Rank
- Internal Medicine II, Medical Faculty, University of Augsburg, Augsburg, Germany
| | - Malte Kircher
- Nuclear Medicine, Medical Faculty, University of Augsburg, Augsburg, Germany
| | - Constantin Lapa
- Nuclear Medicine, Medical Faculty, University of Augsburg, Augsburg, Germany.
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20
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Armstrong KA, Cohen JV, Shepard JAO, Folch EE, Mansour MK, Stefely JA. Case 16-2020: A 47-Year-Old Woman with Recurrent Melanoma and Pulmonary Nodules. N Engl J Med 2020; 382:2034-2043. [PMID: 32433841 DOI: 10.1056/nejmcpc1916258] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Affiliation(s)
- Katrina A Armstrong
- From the Departments of Medicine (K.A.A., J.V.C., E.E.F., M.K.M.), Radiology (J.-A.O.S.), and Pathology (J.A.S.), Massachusetts General Hospital, and the Departments of Medicine (K.A.A., J.V.C., E.E.F., M.K.M.), Radiology (J.-A.O.S.), and Pathology (J.A.S.), Harvard Medical School - both in Boston
| | - Justine V Cohen
- From the Departments of Medicine (K.A.A., J.V.C., E.E.F., M.K.M.), Radiology (J.-A.O.S.), and Pathology (J.A.S.), Massachusetts General Hospital, and the Departments of Medicine (K.A.A., J.V.C., E.E.F., M.K.M.), Radiology (J.-A.O.S.), and Pathology (J.A.S.), Harvard Medical School - both in Boston
| | - Jo-Anne O Shepard
- From the Departments of Medicine (K.A.A., J.V.C., E.E.F., M.K.M.), Radiology (J.-A.O.S.), and Pathology (J.A.S.), Massachusetts General Hospital, and the Departments of Medicine (K.A.A., J.V.C., E.E.F., M.K.M.), Radiology (J.-A.O.S.), and Pathology (J.A.S.), Harvard Medical School - both in Boston
| | - Erik E Folch
- From the Departments of Medicine (K.A.A., J.V.C., E.E.F., M.K.M.), Radiology (J.-A.O.S.), and Pathology (J.A.S.), Massachusetts General Hospital, and the Departments of Medicine (K.A.A., J.V.C., E.E.F., M.K.M.), Radiology (J.-A.O.S.), and Pathology (J.A.S.), Harvard Medical School - both in Boston
| | - Michael K Mansour
- From the Departments of Medicine (K.A.A., J.V.C., E.E.F., M.K.M.), Radiology (J.-A.O.S.), and Pathology (J.A.S.), Massachusetts General Hospital, and the Departments of Medicine (K.A.A., J.V.C., E.E.F., M.K.M.), Radiology (J.-A.O.S.), and Pathology (J.A.S.), Harvard Medical School - both in Boston
| | - Jonathan A Stefely
- From the Departments of Medicine (K.A.A., J.V.C., E.E.F., M.K.M.), Radiology (J.-A.O.S.), and Pathology (J.A.S.), Massachusetts General Hospital, and the Departments of Medicine (K.A.A., J.V.C., E.E.F., M.K.M.), Radiology (J.-A.O.S.), and Pathology (J.A.S.), Harvard Medical School - both in Boston
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21
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Levine I, Kalisz K, Smith DA, Tirumani SH, Ramaiya NH, Alessandrino F. Update on Hodgkin lymphoma from a radiologist's perspective. Clin Imaging 2020; 65:65-77. [PMID: 32361412 DOI: 10.1016/j.clinimag.2020.04.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2019] [Revised: 04/08/2020] [Accepted: 04/16/2020] [Indexed: 10/24/2022]
Abstract
Recent advances in the management of Hodgkin lymphoma, due to new staging and response assessment systems as well as new therapies, have redefined the role of imaging for this disease. The purpose of this article is to provide radiologists with an update on the current role of imaging in Hodgkin lymphoma from diagnosis to assessment of treatment response, in view of the new staging and response assessment system and current treatment strategies.
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Affiliation(s)
- Isaac Levine
- Case Western Reserve University School of Medicine, 10900 Euclid Ave., Cleveland, OH 44106, USA
| | - Kevin Kalisz
- Department of Radiology, University Hospitals Cleveland Medical Center, Case Western Reserve University, 11100 Euclid Ave, Cleveland, OH 44106, USA
| | - Daniel A Smith
- Department of Radiology, University Hospitals Cleveland Medical Center, Case Western Reserve University, 11100 Euclid Ave, Cleveland, OH 44106, USA
| | - Sree Harsha Tirumani
- Department of Radiology, University Hospitals Cleveland Medical Center, Case Western Reserve University, 11100 Euclid Ave, Cleveland, OH 44106, USA
| | - Nikhil H Ramaiya
- Department of Radiology, University Hospitals Cleveland Medical Center, Case Western Reserve University, 11100 Euclid Ave, Cleveland, OH 44106, USA
| | - Francesco Alessandrino
- Department of Imaging, Dana Farber Cancer Institute, Harvard Medical School, 450 Brookline Avenue, Boston, MA 02215, USA; Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA 02115, USA.
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22
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Abstract
Thoracic tumors are a leading cause of cancer-related morbidity and mortality. In recent years, developments in oncologic treatments for these tumors have ushered in an era of targeted therapy, and, in many cases, these novel treatments have replaced conventional strategies to become standard therapeutic options, particularly in those with lung cancer. Targeted medical therapies for lung cancer now include angiogenesis inhibitors, tyrosine kinase inhibitors, and immunotherapeutic agents. Several novel ablative therapies have also gained widespread acceptance as alternatives to conventional surgical options in appropriately selected patients. Tumors treated with targeted medical therapies can respond to treatment differently when compared with conventional therapies. For example, pseudoprogression is a well-described phenomenon in patients receiving checkpoint inhibitor immunotherapy in which an initial increase in tumor burden is followed by a decrease in tumor burden and sometimes partial or complete response, while the frequent cavitating responses seen when antiangiogenic agents are used can be difficult to quantify using existing response assessment criteria. In some cases, novel response assessment criteria are needed to adequately capture response. In addition, numerous treatment-related side effects have been described, which are important to recognize, both to ensure appropriate treatment and to avoid misclassification as worsening tumor. Imaging plays a vital role in the assessment of patients receiving targeted medical therapy, and it is essential that thoracic radiologists are familiar with the rationale underpinning these treatments and the expected posttherapy findings.
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23
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Kalisz KR, Ramaiya NH, Laukamp KR, Gupta A. Immune Checkpoint Inhibitor Therapy-related Pneumonitis: Patterns and Management. Radiographics 2019; 39:1923-1937. [PMID: 31584861 DOI: 10.1148/rg.2019190036] [Citation(s) in RCA: 95] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
In recent years, the use of immune checkpoint inhibitor (ICI) therapy has rapidly grown, with increasing U.S. Food and Drug Administration approvals of a variety of agents used as first- and second-line treatments of various malignancies. ICIs act through a unique mechanism of action when compared with those of conventional chemotherapeutic agents. ICIs target the cell surface receptors cytotoxic T-lymphocyte antigen-4, programmed cell death protein 1, or programmed cell death ligand 1, which result in immune system-mediated destruction of tumor cells. Immune-related adverse events are an increasingly recognized set of complications of ICI therapy that may affect any organ system. ICI therapy-related pneumonitis is an uncommon but important complication of ICI therapy, with potential for significant morbidity and mortality. As the clinical manifestation is often nonspecific, CT plays an important role in diagnosis and triage. Several distinct radiographic patterns of pneumonitis have been observed: (a) organizing pneumonia, (b) nonspecific interstitial pneumonia, (c) hypersensitivity pneumonitis, (d) acute interstitial pneumonia-acute respiratory distress syndrome, (e) bronchiolitis, and (f) radiation recall pneumonitis. Published guidelines outline the treatment of ICI therapy-related pneumonitis based on the severity of symptoms. Treatment is often effective, although recurrence is possible. This article reviews the mechanism of ICIs and ICI therapy complications, with subsequent management techniques and illustrations of the various radiologic patterns of ICI-therapy related pneumonitis.©RSNA, 2019.
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Affiliation(s)
- Kevin R Kalisz
- From the Department of Radiology, Duke University Medical Center, Durham, NC (K.R.K.), and Department of Radiology, University Hospitals Cleveland Medical Center, Cleveland, Ohio (N.H.R., K.R.L., A.G.)
| | - Nikhil H Ramaiya
- From the Department of Radiology, Duke University Medical Center, Durham, NC (K.R.K.), and Department of Radiology, University Hospitals Cleveland Medical Center, Cleveland, Ohio (N.H.R., K.R.L., A.G.)
| | - Kai R Laukamp
- From the Department of Radiology, Duke University Medical Center, Durham, NC (K.R.K.), and Department of Radiology, University Hospitals Cleveland Medical Center, Cleveland, Ohio (N.H.R., K.R.L., A.G.)
| | - Amit Gupta
- From the Department of Radiology, Duke University Medical Center, Durham, NC (K.R.K.), and Department of Radiology, University Hospitals Cleveland Medical Center, Cleveland, Ohio (N.H.R., K.R.L., A.G.)
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24
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Neoadjuvant systemic therapy in melanoma: recommendations of the International Neoadjuvant Melanoma Consortium. Lancet Oncol 2019; 20:e378-e389. [DOI: 10.1016/s1470-2045(19)30332-8] [Citation(s) in RCA: 107] [Impact Index Per Article: 21.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2019] [Revised: 04/08/2019] [Accepted: 04/18/2019] [Indexed: 12/25/2022]
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