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Granuloma/sarcoidosis toxicity

Forums Cutaneous Melanoma Community Granuloma/sarcoidosis toxicity

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      I m stage 3c. I got a  call yesterday from pulmonologist aka lung doctor who did my biopsy.

      I m getting Keytruda since October 2020.
      They biopsed from 3 different spots and it showed granuloma/sarcoidosis. It is a side effect/toxicity of check point inhibitors like Keytruda or Ipi or Ipi/nivo. People get pneumonitis, colitis or they can get this.
      She mentioned prednisone treatment. I didnt talk to oncologist yet.
      I wonder if he will want me to stop treatment permanently  or just to stop for little bit?
      What are my other options if he will stop it since they all are causing the same toxicity and my immune system got super charged with  Keytruda getting this autoimmune response.
      I feel fine. Some pain in my hands and fell hard lumps in the small bones of my hands but nothing else. People with more serious side effects take breaks  and continue treatments. I need to keep going! Anybody had experience with something like this?

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          Hi Daisy,

          I have read that treatment isn’t usually recommended to be stopped because of sarcoidosis. In fact some think that it is an indication that the treatment is working. Likewise  steroids are not always recommended but it is probably between you and your doctor. Very much depends on how you feel,  the extent of sarcoidosis etc.

          You can Google sarcoidosis and ici (immune checkpoint inhibitors) to get the relevant articles…


          in any case it’s much better than progression ! :)

            Thank you Melwave for your reply.

            I wonder what the oncologist will say. I have an appointment with him on Friday. I try not to think about it otherwise I have trouble sleeping.
            I wonder about other spots close to my primary site there were couple suspicious spots there. From what I read usually sarcoidosis happens in lungs. Did you go to my leg? Not sure if he would want biopsy my poor leg which already had 3 surgeries and looks pretty disfigured.
            Fighting cancer is no joke. It’s a mental exercise itself.  Stay positive despite bad news, hope for good news and miracles!

            Don’t give up the fight!!!

              Daisy, sarcoidosis can happen anywhere in the body and in fact very often happens on the skin. So what you have on your leg could well be sarcoidosis too. Perhaps you would not need to biopsy it, just continue with the same treatment and see what happens.

              good luck at your appointment!

                Ok. I had my appointment on Friday. The oncologist said that he personally never had patients respond this way. Rolling eyes here!
                He said it’s definitely described in a literature. He wants me to continue treatment and I agree. I want keep going. He said they presume that all sites which lighted up on a PET scan are the same granuloma/sarcoidosis lesions high were biopsies in 3 different spots in my lungs. He will just keep watching me. He said he doesn’t  think it’s a sign that I am super responder.
                I talked to the other oncologist who deals with melanoma for many years and he said it’s a sign of a super responder. He would recommend to stop treatment and watch. I don’t agree.
                I plan to talk to DR. Weber from NYC and see what he says.
                it’s kind of little weird that my oncologist never had patient responding this way and it’s weird they say quite different things and offer different plan. Any ideas?  Thanks!
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