Ces radiol. 2024, 78(2):125-131 | DOI: 10.55095/CesRadiol2024/017

18F-FDG PET/CT detection of sarcoid-like reaction associated to immune checkpoint inhibitors (ipilimumab/nivolumab) in a 74-year-old woman with malignant melanomaOriginal article

Jiří Doležal1, Jindřich Kopecký2, Dagmar Kalousová3
1 Oddělení nukleární medicíny LF UK a FN, Hradec Králové
2 Klinika onkologie a radioterapie LF UK a FN, Hradec Králové
3 Radiologická klinika LF UK a FN, Hradec Králové

Aim: To present an interesting case of 18F-FDG PET/CT detection ofsarcoid-like reaction associated to immune checkpoint inhibitors(ipilimumab/nivolumab) in a 74-year-old woman with malignant melanoma.

Method: PET/CT scan including head and lower limbs was performed in 60 minutesafter intravenous administration of 18F-FDG with activity of 3.5 MBq/kg.Monophasic contrast-enhanced CT imaging was performed in identical extent.Acquisition of CT imaging data was targeted to the venous circulation.

Results: After immunotherapy, there was partial regression of melanomametastasis in the right groin and right lower limb, but newly showed increased18F-FDG uptake in hilar and mediastinal lymph nodes and FDG avid foci in thelungs. Because of the symmetric involvement, an inflammatory sarcoid-likereaction was suspected as an adverse effect of ipilimumab/nivolumab therapy.The patient was in good clinical condition, asymptomatic, and maintenancetreatment with immunotherapy was continued. Further PET/CT scan showedprogression of FDG avid lymphadenopathy in the mediastinum. Transbronchiallymph node biopsy revealed a sarcoid-like inflammatory reaction afterimmunotherapy.

Conclusion: Checkpoint inhibitor therapy provides a significant improvement insurvival for patients with metastatic melanoma, but also introduces new,previously unknown side effects that complicate the evaluation of 18F-FDGPET/CT scans and carry the risk of -positive findings. Interdisciplinarycollaboration is essential to correctly interpret imaging findings and todistinguish side effects from disease progression. This approach allowedadequate response to PET/CT findings and avoided unnecessary change oftreatment regimen based on -positive findings.

Keywords: melanoma, immune checkpoint inhibitor, sarcoid-like, 18F-FDG, PET/CT

Published: June 1, 2024  Show citation

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Doležal J, Kopecký J, Kalousová D. 18F-FDG PET/CT detection of sarcoid-like reaction associated to immune checkpoint inhibitors (ipilimumab/nivolumab) in a 74-year-old woman with malignant melanoma. Ces radiol. 2024;78(2):125-131. doi: 10.55095/CesRadiol2024/017.
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    References

    1. Wolchok JD, Chiarion-Sileni V, Gonzalez R, Grob J-J, Rutkowski P, Lao ChD, Lance Cowey C, Schadendorf D, Wagstaff J, et al. Long-term outcomes with Nivolumab plus ipilimumab or Nivolumab alone versus Ipilimumab in patients with advanced melanoma. J Clin Oncol. 2022; 40(2): 127-137. Go to original source... Go to PubMed...
    2. Tarhini A, Lo E, Minor DR. Releasing the brake on the immune system: ipilimumab in melanoma and other tumors. Cancer Biother Radiopharm. 2010; 25(6): 601-613. Go to original source... Go to PubMed...
    3. Guo L, Zhang H, Chen B. Nivolumab as Programmed Death-1 (PD-1) Inhibitor for Targeted Immunotherapy in Tumor. J Cancer 2017; 8(3): 410-416. Go to original source... Go to PubMed...
    4. Fínek J. Nivolumab. Remedia 2019; 29(3): 241-246. Go to original source...
    5. Onesti CE, Frères P, Jerusalem G. Atypical patterns of response to immune checkpoint inhibitors: interpreting pseudoprogression and hyperprogression in decision making for patients' treatment. J Thorac Dis. 2019; 11(1): 35-38. Go to original source... Go to PubMed...
    6. Kopecký J, Kubeček O. Jak zvládnout nežádoucí účinky imunoterapie. Onkologie 2020; 14(Suppl C): 6-12. Go to original source...
    7. Tan I, Malinzak M, Salama AKS. Delayed onset of neurosarcoidosis after concurrent ipilimumab/nivolumab therapy. J Immunother Cancer 2018: 6(1): 77. doi:10.1186/s40425-018-0390-2 Go to original source... Go to PubMed...
    8. Eljilany I, Noor A, Paravathaneni M, Yassine I, Lee SJ, Othus M, Moon J, Kirkwood JM, Sondak VK, Ribas A, Grossmann KF, Tarhini AA. Granulomatous and sarcoid-like immune-related adverse events following CTLA4 and PD1 blockade adjuvant therapy of melanoma: A combined analysis of ECOG-ACRIN E1609 and SWOG S1404 Phase III trials and literature review. Cancers (Base) 2023; 15(9): 2561. doi:10.3390/cancers15092561 Go to original source... Go to PubMed...
    9. Kang HJ, Kim Y, Bae JY, Chang JH, Lee SH. Sarcoid-Like Reaction after Complete Remission of Malignancy: CT and 18F-FDG PET/CT Features for the Differential Diagnosis from Lymph Node Metastasis. J Korean Soc Radiol. 2021; 82(4): 903-913. doi:10.3348/jksr.2020.0091. [Epub 2020 Dec 23]. PMID: 36238067; PMCID: PMC9514401. Go to original source... Go to PubMed...
    10. Tetzlaff MT, Nelson KC, Diab A, Staerkel GA, Nagarajan P, Torres-Cabala CA, Chasen BA, Wargo JA, Prieto VG, Amaria RN, Curry JL. Granulomatous/sarcoid- -like lesions associated with checkpoint inhibitors: a marker of therapy response in a subset of melanoma patients. J Immunother Cancer 2018; 6(1): 14. doi:10.1186/s40425-018-0323-0. PMID: 29433571; PMCID: PMC5810034. Go to original source... Go to PubMed...
    11. Ziessman HA, O'Malley J, Thrall JH. Nuclear Medicine - The Requisites in Radiology, Third Edition. Philadelphia, USA: Elsevier Mosby 2006; 302-305.
    12. Li Y, Flavell RR, Juarez R, Chow M, Wu C, Tsai K, Daud A, Behr SC. Retrospective study of the incidence of sarcoidosis-like reaction in patients treated with immunotherapy. Clin Radiol. 2023; 78(2): e131-e136. doi:10.1016/j.crad.2022.09.127 [Epub 2022 Nov 4]. PMID: 36344282. Go to original source... Go to PubMed...
    13. Rodriquez E, Lipson E, Suresh K, Cappelli LC, Monaco SE. Maleki Z. Immune checkpoint blocker-related sarcoid-like granulomatous inflammation: a rare adverse event detected in lymph node aspiration cytology of patients treated for advanced malignant melanoma. Hum Pathol 2019; 91: 69-76 doi:10.1016/j.humpath.2019.07.001 [Epub 2019 Jul 4]. PMID: 31279873. Go to original source... Go to PubMed...
    14. Cao Y, Afzal MZ, Gutmann EJ, Shirai K. Rare immune-related adverse events in a patient with metastatic melanoma: a case report highlighting sarcoidosis- -like reactions triggered by immune-checkpoint inhibitors. Melanoma Res. 2024; 34(1): 70-75. Go to original source... Go to PubMed...
    15. Danlos FX, Pagès C, Baroudjian B, Vercellino L, Battistella M, Mimoun M, Jebali M, Bagot M, Tazi A, Lebbé C. Nivolumab-Induced Sarcoid-Like Granulomatous Reaction in a Patient With Advanced Melanoma. Chest 2016; 149(5): e133-136. doi:10.1016/j.chest.2015.10.082. PMID: 27157227. Go to original source... Go to PubMed...
    16. Keukeleire S, Schwarze J, Awada G, Everaert H, Van Binst AM, Cras L, Neyns B, Aspeslagh S. An atypical sarcoid-like reaction during anti-protein death 1 treatment in a patient with metastatic melanoma. Melanoma Res. 2020; 30(5): 524-527. doi:10.1097/CMR.0000000000000680. PMID: 32898392. Go to original source... Go to PubMed...

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