Immune checkpoint inhibitor-induced sarcoidosis-like granulomas

Area of Science:

• Oncology
• Immunology
• Dermatology

Background:

• Immune checkpoint inhibitors (ICIs) targeting CTLA-4 and PD-1 have revolutionized cancer therapy.
• These treatments can induce immune-related adverse events (irAEs).
• Sarcoidosis-like granulomas (SLGs) are a recognized, yet often overlooked, irAE.

Purpose of the Study:

• To systematically review the literature on ICI-induced SLGs in cancer patients.
• To discuss the potential pathophysiological mechanisms underlying SLG development.
• To highlight the clinical significance of recognizing SLGs in cancer management.

Main Methods:

• Systematic literature review of case reports and series.
• Analysis of patient data and clinical presentations of SLGs.
• Review of proposed immunological mechanisms for granuloma formation.

Main Results:

• ICI-induced SLGs are a significant irAE across various cancer types.
• SLGs can present with diverse clinical manifestations, often mimicking disease recurrence or progression.
• Recognition of SLGs is critical to avoid misinterpretation and inappropriate treatment changes.

Conclusions:

• Sarcoidosis-like granulomas are an important immune-related adverse event associated with immune checkpoint inhibitors.
• Accurate identification of SLGs is essential for appropriate patient management and treatment continuation.
• Further research into the mechanisms of ICI-induced granulomatous reactions is warranted.