title: Sarcoidosis in a patient with metastatic melanoma sequentially treated with anti-CTLA-4 monoclonal antibody and selective BRAF inhibitor.
abstract: A female patient with stage IV-M1c (distant lymph node and breast metastases), chemotherapy-refractory melanoma was treated with the cytotoxic T-lymphocyte antigen 4 (CTLA-4)-inhibitory monoclonal antibody ipilimumab. At first evaluation following induction treatment, there was marked increase in the volume of the lymphadenopathies (including new adenopathies) and strong uptake of (18)Fluorodeoxy-D-glucose ((18)FDG); marked enlargement of the spleen and interstitial lung infiltrates were also observed. Non-necrotising granulomas were discovered on transbronchial mucosal biopsy and cytology on bronchoalveolar lavage established the diagnosis of sarcoidosis. There was a marked clinical and (18)FDG-positron emission tomography/computed tomography ((18)FDG-PET/CT) documented response following six weeks of corticotherapy. At follow-up, progression of subdiaphragmatic melanoma lymph node metastases was documented. Regression of these metastatic sites was observed during treatment with the selective v-Raf murine sarcoma viral oncogene homolog B1 (BRAF) inhibitor vemurafenib. The patient died due to progressive disease after three months of vemurafenib treatment. Our case report illustrates the need to take into consideration exacerbation of sarcoidosis as a potential confounder in the assessment of tumor response in a melanoma patient treated with the anti-CTLA-4 mononclonal antibody ipilimumab.
authors.affiliation: Department of Medical Oncology, UZ Brussel, Brussels, Belgium.
authors.forename: Sofie
authors.initials: S
authors.lastname: Wilgenhof
authors.forename: Veerle
authors.initials: V
authors.lastname: Morlion
authors.forename: Amélie Clémentine
authors.initials: AC
authors.lastname: Seghers
authors.forename: Stephanie
authors.initials: S
authors.lastname: Du Four
authors.forename: Esther
authors.initials: E
authors.lastname: Vanderlinden
authors.forename: Shane
authors.initials: S
authors.lastname: Hanon
authors.forename: Frederik
authors.initials: F
authors.lastname: Vandenbroucke
authors.forename: Hendrik
authors.initials: H
authors.lastname: Everaert
authors.forename: Bart
authors.initials: B
authors.lastname: Neyns
mesh_terms: D000911:Antibodies, Monoclonal / Q000627:therapeutic use*; D000970:Antineoplastic Agents / Q000627:therapeutic use*; D005260:Female; D006801:Humans; D000074324:Ipilimumab; D008545:Melanoma / Q000150:complications / Q000188:drug therapy* / Q000473:pathology; D008875:Middle Aged; D064847:Multimodal Imaging; D009362:Neoplasm Metastasis; D049268:Positron-Emission Tomography; D048493:Proto-Oncogene Proteins B-raf / Q000037:antagonists & inhibitors*; D012507:Sarcoidosis / Q000150:complications*; D014057:Tomography, X-Ray Computed
chemical_list: D000911:Antibodies, Monoclonal; D000970:Antineoplastic Agents; D000074324:Ipilimumab; C482119:BRAF protein, human; D048493:Proto-Oncogene Proteins B-raf