3 years ago

Granulomatose sarcoïdosique survenant sous inhibiteurs de point de contrôle immunitaire

G. Faviez, E. Bousquet, A. Rabeau, I. Rouquette, S. Collot, C. Goumarre, N. Meyer, G. Prevot, J. Mazieres

Publication date: November 2018

Source: Revue des Maladies Respiratoires, Volume 35, Issue 9

Author(s): G. Faviez, E. Bousquet, A. Rabeau, I. Rouquette, S. Collot, C. Goumarre, N. Meyer, G. Prevot, J. Mazieres

Résumé
Introduction

Les inhibiteurs de point de contrôle immunitaire sont de plus en plus largement utilisés dans la thérapeutique anticancéreuse avec une extension des indications. Leur toxicité est polymorphe, comprenant des atteintes dysimmunitaires spécifiques d’organe et le développement plus rare d’atteintes systémiques.

Observations

Nous rapportons 3 cas de granulomatose sarcoïdosique développée durant un traitement par inhibiteurs de point de contrôle immunitaire (dans des tumeurs primitives différentes : adénocarcinome bronchique, cancer bronchique à petites cellules et mélanome). La présentation radioclinique et la gravité de l’atteinte étaient variables. Le diagnostic reposait sur l’examen anatomo-pathologique et l’élimination des diagnostics différentiels, notamment infectieux. Dans ce cas, l’immunothérapie doit être stoppée et sa ré-administration ultérieure reste à déterminer. Une corticothérapie systémique est discutée selon l’intensité des symptômes.

Conclusions

La connaissance de cette toxicité est primordiale car les signes clinico-radiologiques peuvent faire évoquer une progression tumorale.

Summary
Introduction

Immune checkpoint inhibitors are becoming a standard treatment for many different cancers. Their toxicities are variable and include organ-specific dysimmune injuries and the development of systemic diseases.

Case report

We report 3 cases of sarcoid-like granulomatosis that occurred during treatment of various types of primary cancer by immune checkpoint inhibitors: lung adenocarcinoma, small cell lung cancer and melanoma. The clinical presentation, radiologic pattern and severity of this toxicity were variable. The diagnosis was made on biopsy with pathological examination and exclusion of differential diagnoses, particularly infection. In such cases, immunotherapy should be discontinued and subsequent rechallenge discussed later. Systemic corticosteroids should be considered depending on the severity of symptoms.

Conclusions

Knowledge of this toxicity is crucial as the clinical signs and radiological patterns may suggest tumour progression.

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