Sarcoidosis-like reaction after neoadjuvant pembrolizumab combined with chemotherapy mimicking disease progression of NSCLC induced encouraging discovery of pathological complete response

Yuequan Shi, Ji Li, Minjiang Chen, Hongsheng Liu, Dongjie Ma, Yuxiao Lin, Mengzhao Wang, Yan Xu, Yuequan Shi, Ji Li, Minjiang Chen, Hongsheng Liu, Dongjie Ma, Yuxiao Lin, Mengzhao Wang, Yan Xu

Abstract

Neoadjuvant chemoimmunotherapy has demonstrated improved efficacy and prognosis in stage IIa-IIIb patients with non-small cell lung cancer (NSCLC). Drug-induced sarcoidosis-like reaction (DISR), an autoimmune reaction, has been reported as a type of immune-related adverse event that may mimic disease progression. Here, we report the case of patient with NSCLC who developed DISR during neoadjuvant chemoimmunotherapy and finally achieved pathological complete response after surgery.

Trial registration: ClinicalTrials.gov NCT02716038 NCT03197467.

Keywords: drug-induced sarcoidosis-like reaction; neoadjuvant chemoimmunotherapy; non-small cell lung cancer; pathological complete response.

Conflict of interest statement

The authors declare that they have no conflict of interest for this article.

© 2021 The Authors. Thoracic Cancer published by China Lung Oncology Group and John Wiley & Sons Australia, Ltd.

Figures

FIGURE 1
FIGURE 1
Contrast‐enhanced chest computed tomography (CT) scan and pathological images of a 68‐year‐old female patient with non‐small cell lung cancer. Contrast‐enhanced chest CT scan (a)–(d) showing left upper lobe mass without mediastinal lymph node enlargement before neoadjuvant therapy. Contrast‐enhanced chest CT scan (e)–(h) showing left upper lobe mass with enlarged N7, 10L, and 10R lymph nodes after two cycles of treatment. Contrast‐enhanced chest CT scan (i)–(l) showing a shrunken left upper lobe mass with enlarged N7, 10L, and 10R lymph nodes after four cycles of treatment
FIGURE 2
FIGURE 2
(a) Hematoxylin and eosin (HE) staining of the tumor bed (150x) with viable tumor cells before neoadjuvant therapy. (b) HE‐staining of the tumor bed (150x) with noncaseating granulomas and peripheral lymphocytic infiltrates, and no surviving tumor cells after neoadjuvant therapy. (c) HE‐staining of the post‐surgical N5R lymph node (150x) forming sarcoidosis‐like reaction. (d) CD4‐staining of the post‐surgical N5R lymph node (60x). (e) CD8‐staining of the post‐surgical N5R lymph node (60x). (f) CD68‐staining of the post‐surgical N5R lymph node (60x)

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Source: PubMed

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