Anastasopoulou Amalia, Diamantopoulos Panagiotis T, Skalioti Chrysanthi, Liapis George, Psychogiou Eleni, Ziogas Dimitrios C, Gogas Helen
First Department of Internal Medicine, Laikon General Hospital, National and Kapodistrian University of Athens, Greece.
First Department of Internal Medicine, Laikon General Hospital, National and Kapodistrian University of Athens, 17 Agiou Thoma street, Athens, 11527, Greece.
Ther Adv Med Oncol. 2021 Oct 20;13:17588359211047349. doi: 10.1177/17588359211047349. eCollection 2021.
Sarcoidosis and sarcoid-like reactions (SLR) have been repeatedly reported in patients with melanoma treated with BRAF and MEK inhibitors. In the current study we present three patients that developed SLR under treatment with BRAF and mitogen-activated protein kinase (MEK) inhibitors for melanoma. Two patients developed mediastinal lymphadenitis with histological features of an SLR while on targeted therapy in the adjuvant setting, whereas one patient with metastatic melanoma developed granulomatous nephritis while receiving combination treatment with BRAF/MEK inhibitors and atezolizumab. In addition, we review the published literature on the pathogenesis, clinical characteristics, histologic features, imaging findings, and other potential useful diagnostic tools. We also address the need for a common terminology for these cases and propose an algorithm for the accurate diagnosis of BRAF/MEK inhibitor-induced SLR. We also review the currently available data on the treatment of these patients and suggest a treatment approach for SLR in patients with melanoma, as well as for the management of melanoma when SLR emerges.
结节病和结节病样反应（SLR）在接受BRAF和MEK抑制剂治疗的黑色素瘤患者中屡有报道。在本研究中，我们介绍了3例在接受BRAF和丝裂原活化蛋白激酶（MEK）抑制剂治疗黑色素瘤期间发生SLR的患者。2例患者在辅助治疗中接受靶向治疗时出现具有SLR组织学特征的纵隔淋巴结炎，而1例转移性黑色素瘤患者在接受BRAF/MEK抑制剂与阿特珠单抗联合治疗时出现肉芽肿性肾炎。此外，我们回顾了已发表的关于发病机制、临床特征、组织学特征、影像学表现及其他潜在有用诊断工具的文献。我们还讨论了针对这些病例采用通用术语的必要性，并提出了一种准确诊断BRAF/MEK抑制剂诱导的SLR的算法。我们还回顾了目前关于这些患者治疗的可用数据，并提出了黑色素瘤患者SLR的治疗方法，以及SLR出现时黑色素瘤的管理方法。
