Abstract

BackgroundWe report a case of sarcoidosis in a patient with metastatic melanoma managed with combination ipilimumab/nivolumab. Sarcoid development has been linked with single agent immunotherapy but, to our knowledge, it...

Highlights

  • We report a case of sarcoidosis in a patient with metastatic melanoma managed with combination ipilimumab/nivolumab

  • The diagnosis of sarcoidosis in melanoma patients has been made in a diverse array of clinical settings, including sequential and/or concurrent diagnoses, and following initiation of anti-melanoma therapy

  • Sarcoidosis development has been reported in untreated melanoma patients and those managed with interferon, peptide vaccine, vemurafenib, ipilimumab and nivolumab [5,6,7,8,9,10,11,12,13,14, 16,17,18,19,20,21]

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Summary

Conclusions

The diagnosis of sarcoidosis in melanoma patients has been made in a diverse array of clinical settings, including sequential and/or concurrent diagnoses, and following initiation of anti-melanoma therapy. The mediastinal and hilar lymph nodes did not respond to immunotherapy treatment, despite response in all other sites present on baseline evaluation, and the adenopathy progressed with the development of the biopsy-proven cutaneous sarcoid lesions. Consistent with this, Xu et al demonstrated diffuse, strong, membranous positivity for PD-L1 in 100% and PD-L2 positivity in 86% of evaluated sarcoidosis cases [27] These results suggest a possible therapeutic role for anti-PD-1 therapy in patients with sarcoidosis, though this idea is countered by the cases of sarcoid development in the setting of nivolumab and pembrolizumab therapy. There were multiple variables contributing to the clinical scenario and the driver for the sarcoid progression was unclear She had received both ipilimumab and nivolumab in combination around the time of the clinical change, but in retrospect likely had sarcoidosis at baseline.

Background
Findings

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