Aim: To evaluate adverse events in cancer patients with pre-existing sarcoidosis receiving immune checkpoint inhibitors (ICIs). Patients & methods: We retrospectively reviewed cancer patients with sarcoidosis who underwent treatment with ICI to determine frequency of sarcoidosis flares. Results: 32 patients with sarcoidosis received ICIs The median time to ICI initiation was 7 years (range: 1 month to 51 years). One patient (3%) with a 20-year remote history of sarcoidosis developed a clinically symptomatic exacerbation after three doses of atezolizumab, with hilar lymphadenopathy, subcutaneous nodules, arthritis and uveitis. Atezolizumab was discontinued and prednisone initiated. She had a fluctuating course with two additional flares. Conclusion: Frequency of flares in patients with a remote history of sarcoidosis who receive ICIs is low.
Keywords: PD-1; Sarcoidosis; atezolizumab; cancer immunotherapy; immune checkpoint inhibitor; immune-related adverse events.
Lay summary Immune checkpoint inhibitors have revolutionized the treatment of cancer. However, because they increase patients’ immune responses, they can cause inflammatory and autoimmune adverse events. There are some concerns that patients with cancer who have pre-existing autoimmune or inflammatory disorders may flare when they receive these agents. We report 32 patients with cancer who had a history of sarcoidosis and received immune checkpoint inhibitors. Of these, only one had a flare of sarcoidosis and the patient required treatment. Our findings suggest that most cancer patients with a remote history of sarcoidosis can receive immune checkpoint inhibitors without experiencing sarcoidosis flares.