Faviez G, Bousquet E, Rabeau A, Rouquette I, Collot S, Goumarre C, Meyer N, Prevot G, Mazieres J
Service de pneumologie, université Paul-Sabatier, centre hospitalier universitaire, hôpital Larrey, 31059 Toulouse, France; Centre hospitalier universitaire, hôpital Larrey, 31059 Toulouse, France.
Service d'anatomopathologie, centre hospitalier universitaire, institut universitaire du cancer, 31059 Toulouse, France.
Rev Mal Respir. 2018 Nov;35(9):963-967. doi: 10.1016/j.rmr.2018.08.003. Epub 2018 Sep 13.
Immune checkpoint inhibitors are becoming a standard treatment for many different cancers. Their toxicities are variable and include organ-specific dysimmune injuries and the development of systemic diseases.
We report 3 cases of sarcoid-like granulomatosis that occurred during treatment of various types of primary cancer by immune checkpoint inhibitors: lung adenocarcinoma, small cell lung cancer and melanoma. The clinical presentation, radiologic pattern and severity of this toxicity were variable. The diagnosis was made on biopsy with pathological examination and exclusion of differential diagnoses, particularly infection. In such cases, immunotherapy should be discontinued and subsequent rechallenge discussed later. Systemic corticosteroids should be considered depending on the severity of symptoms.
Knowledge of this toxicity is crucial as the clinical signs and radiological patterns may suggest tumour progression.
免疫检查点抑制剂正成为许多不同癌症的标准治疗方法。其毒性各不相同,包括器官特异性免疫功能紊乱损伤和全身性疾病的发生。
我们报告了3例在免疫检查点抑制剂治疗各种原发性癌症(肺腺癌、小细胞肺癌和黑色素瘤)期间发生的结节病样肉芽肿病。这种毒性的临床表现、放射学模式和严重程度各不相同。通过活检进行病理检查并排除鉴别诊断,尤其是感染后做出诊断。在这种情况下,应停止免疫治疗,后续重新挑战的问题稍后再讨论。应根据症状的严重程度考虑使用全身性皮质类固醇。
了解这种毒性至关重要,因为临床体征和放射学模式可能提示肿瘤进展。