Immune checkpoint inhibitor cancer therapy increases risk for sarcoidosis

NASHVILLE, Tenn. — Patients who received immune checkpoint inhibitor therapy may have a greater risk for sarcoidosis, according to study results presented at CHEST Annual Meeting.

However, the clinical significance of these findings on cancer prognosis remained unknown.

“This increased incidence is especially pronounced in patients with a primary diagnosis of melanoma,” Robert Easterling, MD, internist at The Ohio State University Wexner Medical Center, and colleagues wrote in their abstract.

The aim of the study was to assess the incidence of sarcoidosis among patients with cancer after immune checkpoint inhibitor (ICI) therapy and whether checkpoint inhibitor-related sarcoidosis has a protective effect on cancer recurrence.

Easterling and colleagues evaluated consecutive patients treated with ICI therapy from 2013 to 2020 at a tertiary medical center in Columbus, Ohio. Board-certified pulmonologists on the study team reviewed all cases, determining sarcoidosis based on the presence of non-necrotizing granulomas on tissue biopsy and the lack of an alternate diagnosis such as cancer progression or infection.

During the study period, researchers observed eight sarcoidosis cases following ICI therapy among 2,964 patients, equating to a 0.27% sarcoidosis incidence after ICI therapy initiation.

Mean time from ICI therapy to diagnosis of sarcoid was 487 days (range, 101-1,335) and the mean number of ICI infusions received was 26 (range, 5-75).

Furthermore, data indicated that melanoma, with 518 cases in the total patient population, was the most common primary cancer for six of the sarcoidosis cases following ICI therapy. Lung cancer, which had a total 1,075 cases in the total patient population, was the primary cancer for two sarcoidosis cases.

“The incidence of sarcoidosis in lung cancers may be underrepresented because new or progressive lymphadenopathy in these patients may be less likely to be re-biopsied,” Easterling and colleagues wrote.

In other data, all eight patients had pulmonary involvement in their sarcoidosis, one had skin involvement and one had liver/gastrointestinal involvement. Four patients had progression of their cancer after starting ICI and three died; one patient who had progression on ICI did not have any further progression after diagnosis of sarcoid. No one received sarcoid-directed treatment.

“Sarcoidosis is an underrecognized side effect of ICI, though its clinical significance on cancer prognosis is not clear,” the researchers wrote. “Cancer patients on ICI with progressive lymphadenopathy may not be from disease progression, and biopsy should be considered to rule out a sarcoid-like response, especially in melanoma patients who appear to have a higher incidence of post-treatment sarcoidosis. Further investigation will be needed to determine [the] effects of sarcoidosis on cancer recurrence in a larger cohort that underwent sarcoid-directed therapies and ... whether treatment of post-checkpoint inhibitor sarcoidosis impacts cancer recurrence.”

Reference:

Easterling R, et al. Chest. 2022;doi:10.1016/j.chest.2022.08.2171.