einstein (São Paulo). 19/Mar/2024;22:eAI0810.
Sarcoid-like reaction induced by neoadjuvant immunotherapy in Stage III non-small cell lung cancer
Leonardo Chaves Machado
, Eduardo Kaiser Ururahy Nunes Fonseca
, Genival Viana de Oliveira Júnior
, Gustavo Schvartsman
, Rodrigo Caruso Chate
DOI: 10.31744/einstein_journal/2024AI0810
Lung cancer represents the most commonly diagnosed neoplasm and the leading cause of cancer-related death worldwide, with majority of the patients being histologically categorized as non-small cell lung cancer. We present the case of a 54-year-old male patient, with a smoking history of 30 pack-years and no other comorbidities, with a pulmonary mass in the left lower lobe () incidentally revealed by computed tomography (CT). After pathological confirmation of adenocarcinoma with hilar lymph node metastasis (cT2b pN1 M0, EIIB), the patient underwent neoadjuvant therapy with carboplatin AUC6, pemetrexed 500mg/m2, and nivolumab 360mg (three cycles with a three-week interval), with a planned curative lower left lobectomy and lymph node dissection. Positron emission tomography (PET)-CT images following neoadjuvant treatment revealed increased size and heterogeneous enhancement of bilateral mediastinal and hilar lymph nodes (). Concerns about disease progression were raised, but histological analysis indicated a granulomatous reaction consistent with a sarcoid-like reaction (SLR), with post-neoadjuvant pathological staging of ypT1c ypN0.
When considering oncological treatment, an SLR refers to a non-caseating granulomatous reaction observed in patients receiving active treatment.(-) Sarcoid-like reactions have been associated with various drugs, including anti-programmed cell death protein 1 (PD-1) inhibitors like nivolumab.() This drug triggers an antitumor response, slows tumor growth, and promotes tumor rejection by stimulating memory antigen-specific T cell proliferation.() The mechanism underlying SLR remains unclear; however, it has been postulated that PD-1 blockade enhances interferon-gamma release, which may reactivate previous immune responses.(,,)
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