Thoracic and cutaneous sarcoid-like reaction associated with anti-PD-1 therapy: longitudinal monitoring of PD-1 and PD-L1 expression after stopping treatment

• Published in: Journal for immunotherapy of cancer Vol. 6; no. 1; p. 52
• Main Authors: Paolini, Léa, Poli, Caroline, Blanchard, Simon, Urban, Thierry, Croué, Anne, Rousselet, Marie-Christine, Le Roux, Sarah, Labarrière, Nathalie, Jeannin, Pascale, Hureaux, José
• Format: Journal Article
• Language: English
• Published: England BioMed Central Ltd 13.06.2018; BMJ Publishing Group LTD; BMJ Publishing Group; BioMed Central
• Subjects: Antineoplastic Agents, Immunological - adverse effects; B cells; B7-H1 Antigen - immunology; Cancer; Cancer therapies; Carcinoma, Non-Small-Cell Lung - drug therapy; Carcinoma, Non-Small-Cell Lung - immunology; Care and treatment; Case Report; Comparative analysis; Complications and side effects; Female; Flow cytometry; Humans; Immunology; Immunotherapy; Leukocytes, Mononuclear - drug effects; Leukocytes, Mononuclear - immunology; Life Sciences; Lung cancer; Lung cancer, Non-small cell; Lung Neoplasms - drug therapy; Lung Neoplasms - immunology; Lymph Nodes - drug effects; Lymph Nodes - pathology; Lymphatic system; Lymphocytes; Medical imaging; Melanoma; Middle Aged; Monoclonal antibodies; Nivolumab; Nivolumab - adverse effects; Patients; Programmed Cell Death 1 Receptor - antagonists & inhibitors; Programmed Cell Death 1 Receptor - immunology; Sarcoid-like reaction; Sarcoidosis; Sarcoidosis - chemically induced; Sarcoidosis - pathology; Sarcoma; Skin - drug effects; Skin - pathology; Skin Diseases - chemically induced; Skin Diseases - pathology; T cells; Targeted cancer therapy; Thorax; Sarcoid-like reaction; Lung cancer; Nivolumab
• ISSN: 2051-1426; 2051-1426
• DOI: 10.1186/s40425-018-0372-4

Immune checkpoint inhibitors (ICI) target T cell inhibitory pathways that are responsible for cancer tolerance by down-modulating immune functions. ICI have revolutionized patients care with lung cancer. Nevertheless, restoring endogenous antitumor T-cell responses can induce immune related adverse events, such as sarcoidosis. We report here the first case of a thoracic and cutaneous sarcoid-like reaction in a patient with a relapsing unresectable non-small cell lung cancer (NSCLC) treated with nivolumab, an anti-PD-1 mAb. The expression of PD-1 and its ligands, PD-L1 and PD-L2, was assessed by flow cytometry on peripheral blood mononuclear cells (PBMC) and compared to patients who had discontinued nivolumab therapy without having developed any immune related adverse events. PD-L1 expression was transiently increased on B cells, T cells and monocytes, whereas PD-L2 expression was not modulated. PD-1 was transiently undetectable when PD-L1 was maximal, before returning to basal level. Sarcoidosis spontaneously resolved, without corticotherapy. This case sheds the light on a complex regulation of PD-L1 expression in vivo on PBMC after nivolumab arrest and triggers the question of monitoring the expression of immune checkpoint on immune cells during and after treatment with ICI.