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Sarcoidosis-like irAE Lung — SCE Medical Oncology MCQ

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ModerateLung CancerSarcoidosis-like irAE LungSCE Medical Oncology

A 62-year-old man with metastatic NSCLC on pembrolizumab develops new bilateral hilar lymphadenopathy on CT. Biopsy of a hilar node shows non-caseating granulomas without malignant cells. What should be done?

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Correct answer: B — Recognise as sarcoidosis-like irAE — this does NOT represent disease progression; continue pembrolizumab if the patient is otherwise well; corticosteroids only if symptomatic

Sarcoidosis-like granulomatous reactions occur in approximately 5-7% of ICI-treated patients and can closely mimic lymph node metastases on CT/PET-CT. Biopsy showing non-caseating granulomas without malignant cells confirms the diagnosis. This is NOT disease progression and ICI can often be continued. Misinterpreting this as progression would lead to unnecessary treatment changes. Asymptomatic cases can be observed; symptomatic cases may need low-dose corticosteroids. TB must always be excluded.

Reference: ESMO 2024 irAE Management; Chopra et al Cancer 2018