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Abstract
Aim: The incidence of drug-induced sarcoidosis-like reactions (DISR) in patients treated with immune checkpoint inhibitors (ICIs) is rising. We determine the incidence and characteristics of DISR in a metastatic renal cell carcinoma (mRCC) population. Methods: We retrospectively reviewed clinico-radiological data of 83 mRCC patients treated at a single institution with immune-based combinations. Results: 15 patients received immune-doublet (ipilimumab–nivolumab), while 68 patients received other immune-based combinations. Two cases of DISR (2.4%) were evidenced, with enlargement of mediastinal lymph nodes that mimicked disease progression, thus requiring a biopsy which showed histological features of DISR. Conclusion: In our series of the incidence of DISR, radiological and clinical features, are in line with literature. DISR diagnosis is often only radiological, and its occurrence is possibly associated with a better outcome.
Plain language summary
The development of sarcoidosis-like lesions (DISR) is a rare event observed in cancer patients receiving immunotherapy. DISR occurrence represents a huge diagnostic issue, because its clinical and radiological features simulate disease progression. We present a series of 83 patients with kidney cancer receiving immunotherapy. During the therapy, two of these patients showed enlargement of chest lymph nodes that could be interpreted as disease progression. However, the microscopic analysis of these lymph nodes showed evidence of DISR. In conclusion, DISR should be adequately recognized to correctly manage patients who receive immunotherapy.
TWEETABLE ABSTRACT
The development of sarcoidosis-like lesions is a rare event in cancer patients receiving immunotherapy. The occurrence of DISR may mimic disease progression, and it represents a diagnostic issue, considering the growing number of resected RCC treated with adjuvant immunotherapy.
Drug-induced sarcoidosis-like reactions (DISR) are described in cancer patients undergoing immunotherapy.
DISR is a relatively rare event observed in renal cell carcinoma patients receiving immune checkpoint inhibitors or immune combinations.
DISR clinical and radiological features might mimic disease progression.
An early and accurate histopathological assessment of DISR is advised for appropriate disease management.
In the adjuvant setting, the differential diagnosis between DISR and disease progression is crucial to avoid inappropriate therapeutic choices.
Author contributions
Conception and design: M Rizzo, L Cosmai, C Porta. Acquisition of data: M Rizzo, G Pezzicoli, C Ganini, C Porta. Analysis and interpretation of data: M Rizzo, L Carone, A Caliò, M Brunelli, L Cosmai, C Porta. Drafting of the manuscript: M Rizzo, L Cosmai, C Porta. Critical revision of the manuscript for important intellectual content: all authors. Statistical analysis: M Rizzo, L Cosmai, C Porta. Supervision: M Rizzo, L Cosmai, C Porta.
Financial disclosure
The authors have no financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.
Competing interests disclosure
The authors have no competing interests or relevant affiliations with any organization or entity with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, stock ownership or options and expert testimony.
Writing disclosure
No writing assistance was utilized in the production of this manuscript.
Ethical conduct of research
This study was a subanalysis of a larger retrospective-prospective observational study, approved by the Internal Review Board/Ethical Committee of the A.O.U. Consorziale Policlinico di Bari (study n. 7370 approved on 29-06-2022, protocol n. 0063750|15/07/22).