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

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Abstract

Background: 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. Case presentation: 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. Conclusion: 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.

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Paolini, L., Poli, C., Blanchard, S., Urban, T., Croué, A., Rousselet, M. C., … Hureaux, J. (2018). Thoracic and cutaneous sarcoid-like reaction associated with anti-PD-1 therapy: Longitudinal monitoring of PD-1 and PD-L1 expression after stopping treatment. Journal for ImmunoTherapy of Cancer, 6(1). https://doi.org/10.1186/s40425-018-0372-4

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