Pulmonary Sarcoidosis Activation following Neoadjuvant Pembrolizumab plus Chemotherapy Combination Therapy in a Patient with Non-Small Cell Lung Cancer: A Case Report

Abstract

Background: Pembrolizumab is a humanized monoclonal antibody which serves to enhance the antitumor immune response by targeting programmed cell death 1 receptor. The use of pembrolizumab plus carboplatin/pemetrexed combination therapy results in improvement in overall survival and progression-free survival rates for non-small cell lung cancer (NSCLC) patients as compared to chemotherapy alone. However, numerous immune-mediated toxicities of pembrolizumab have been reported. Case Presentation: We report the case of a 74-year-old male patient diagnosed with stage IIIA programmed death-ligand 1-positive non-small cell lung adenocarcinoma treated with 4 cycles of carboplatin/pemetrexed plus pembrolizumab combination therapy followed by 2 cycles of pembrolizumab treatment. Follow-up PET-CT scanning showed a very good response at the level of the tumor but new-onset activity in bilateral hilar and mediastinal lymph nodes. Biopsy of these lymph nodes revealed a benign pathology with noncaseating granulomas consistent with immune-mediated sarcoidosis. Conclusion: The pathogenesis of immunotherapy-induced sarcoidosis is not yet known but has been reported in different cancers and using different checkpoint inhibitors. To our knowledge, this case is the first in the literature displaying pulmonary sarcoidosis in a patient with NSCLC 4 months after having initiated chemotherapy plus pembrolizumab combination therapy.

Sarcoidosis‐like reaction in metastatic triple negative breast cancer treated by anti‐PD‐L1

“…Sarcoidosis is a multisystem inflammatory disease. Sarcoidosis‐like reaction has been described in various cancer subtypes treated by anti‐PD1 or anti‐CTLA‐4 but only once by anti‐PD‐L1 . Some reports even reveal extra lymph node localization of sarcoidosis‐like reaction, as skin specific involvement …”

68-months progression-free survival with crizotinib treatment in a patient with metastatic ALK positive lung adenocarcinoma and sarcoidosis: A case report

“…19 However, there have been reports of patients diagnosed with sarcoidosis after the use of immunotherapies. 20–22 There is case reports of sarcoidosis developing in the follow-up of patients with malignant melanoma treated with immune check-point inhibitors such as nivolumab, ipilimumab, and pembrolizumab. Similarly, reports have been made that sarcoidosis is activated in patients using control point inhibitors for the treatment of Hodgkin lymphoma, renal cell carcinoma and sarcoma.…”

Simultaneous Occurrence of Sarcoidosis and Anti-neutrophil Cytoplasmic Antibody-associated Vasculitis in a Patient with Lung Cancer

“…Sarcoidosis and vasculitis were recently reported to occur after immune checkpoint inhibitor therapy (34,35). Immune-related diseases, including sarcoidosis and vasculitis, may become increasingly recognized as immune-related adverse events associated with cancer therapy, in addition to being risk factors for cancer and paraneoplastic syndromes.…”