title: Nivolumab-Induced Sarcoid-Like Granulomatous Reaction in a Patient With Advanced Melanoma.
abstract: To our knowledge, we report the first case of sarcoid-like granulomatous reaction induced by nivolumab, a fully human IgG4 anti-programmed death 1 (PD-1) immune checkpoint inhibitor antibody. A 57-year-old man was treated with nivolumab 3 mg/kg for 2 weeks for a desmoplastic melanoma stage III American Joint Commission on Cancer, with no BRAF, NRAS, and cKit mutations. At 10 months, although melanoma complete response was achieved, he developed sarcoid-like granulomatous reaction in the mediastinal lymph node and skin, which resumed after nivolumab arrest. Melanoma did not relapse after 12 months of follow-up. Considering the recently demonstrated role of activated PD-1/PDL-1 axis in sarcoidosis, granulomatous reaction in the patient seems to be a paradoxical reaction, but similar observations have been reported with ipilimumab, another immune checkpoint inhibitor. Sarcoid-like granulomatous reaction during immunotherapy treatment could be a manifestation of cell-mediated immunity induced by these drugs. Impact of granulomatous reaction induced by immune checkpoint inhibitor on melanoma progression is not known and requires further study. Melanoma patients treated by immunotherapy (anti-cytotoxic T-lymphocyte-associated protein-4/anti-PD-1) should be considered for developing sarcoid-like granulomatous reaction that must not be confused with tumor progression.
authors.affiliation: Dermatology Department, Assistance Publique - Hôpitaux de Paris, Saint Louis Hospital, Paris, France. Electronic address: danloscrh@gmail.com.
authors.forename: François-Xavier
authors.initials: FX
authors.lastname: Danlos
authors.affiliation: Dermatology Department, Assistance Publique - Hôpitaux de Paris, Saint Louis Hospital, Paris, France; Clinical Investigation Department, Assistance Publique - Hôpitaux de Paris, Saint Louis Hospital, Paris, France.
authors.forename: Cécile
authors.initials: C
authors.lastname: Pagès
authors.affiliation: Dermatology Department, Assistance Publique - Hôpitaux de Paris, Saint Louis Hospital, Paris, France; Clinical Investigation Department, Assistance Publique - Hôpitaux de Paris, Saint Louis Hospital, Paris, France.
authors.forename: Barouyr
authors.initials: B
authors.lastname: Baroudjian
authors.affiliation: Nuclear Medicine Department, Assistance Publique - Hôpitaux de Paris, Saint Louis Hospital, Paris, France.
authors.forename: Laetitia
authors.initials: L
authors.lastname: Vercellino
authors.affiliation: Pathology Department, Assistance Publique - Hôpitaux de Paris, Saint Louis Hospital, Paris, France.
authors.forename: Maxime
authors.initials: M
authors.lastname: Battistella
authors.affiliation: Plastic Surgery Department, Assistance Publique - Hôpitaux de Paris, Saint Louis Hospital, Paris, France.
authors.forename: Maurice
authors.initials: M
authors.lastname: Mimoun
authors.affiliation: Dermatology Department, Assistance Publique - Hôpitaux de Paris, Saint Louis Hospital, Paris, France; Clinical Investigation Department, Assistance Publique - Hôpitaux de Paris, Saint Louis Hospital, Paris, France.
authors.forename: Majdi
authors.initials: M
authors.lastname: Jebali
authors.affiliation: Dermatology Department, Assistance Publique - Hôpitaux de Paris, Saint Louis Hospital, Paris, France; Onco-Dermatology, Immunology and Cutaneous Stem Cells, Université Paris Diderot, Sorbonne Paris Cité, Paris, France.
authors.forename: Martine
authors.initials: M
authors.lastname: Bagot
authors.affiliation: Pneumology Department, Assistance Publique - Hôpitaux de Paris, Saint Louis Hospital, Paris, France; Biostatistics and Clinical Epidemiology research team, Université Paris Diderot, Sorbonne Paris Cité, Paris, France.
authors.forename: Abdellatif
authors.initials: A
authors.lastname: Tazi
authors.affiliation: Dermatology Department, Assistance Publique - Hôpitaux de Paris, Saint Louis Hospital, Paris, France; Clinical Investigation Department, Assistance Publique - Hôpitaux de Paris, Saint Louis Hospital, Paris, France; Onco-Dermatology, Immunology and Cutaneous Stem Cells, Université Paris Diderot, Sorbonne Paris Cité, Paris, France.
authors.forename: Céleste
authors.initials: C
authors.lastname: Lebbé
mesh_terms: D000911:Antibodies, Monoclonal / Q000009:adverse effects*; D000970:Antineoplastic Agents / Q000009:adverse effects*; D001706:Biopsy; D006099:Granuloma / Q000139:chemically induced* / Q000000981:diagnostic imaging / Q000473:pathology; D006258:Head and Neck Neoplasms / Q000188:drug therapy*; D006801:Humans; D008198:Lymph Nodes / Q000000981:diagnostic imaging / Q000473:pathology; D008206:Lymphatic Diseases / Q000139:chemically induced* / Q000000981:diagnostic imaging / Q000473:pathology; D008297:Male; D008482:Mediastinum; D008545:Melanoma / Q000188:drug therapy*; D008875:Middle Aged; D000077594:Nivolumab; D049268:Positron-Emission Tomography; D012507:Sarcoidosis / Q000139:chemically induced* / Q000000981:diagnostic imaging / Q000473:pathology; D012878:Skin Neoplasms / Q000188:drug therapy*
chemical_list: D000911:Antibodies, Monoclonal; D000970:Antineoplastic Agents; D000077594:Nivolumab
keywords: PD-1; granulomatosis; melanoma; nivolumab