Necrotizing and Nonnecrotizing Granulomatous Reactions in Patients With Cancer Treated With Immune Checkpoint Inhibitors: A Systematic Literature Review
Authors' conclusion
GRs in patients with cancer treated with ICI can occur in many organ systems and were most commonly nonnecrotizing. Patients treated with combination ICI had more severe reactions. Most GRs resolved with CS treatment or ICI discontinuation.
Study context
- Population
- Patients with cancer receiving immune checkpoint inhibitors (ICI) who developed granulomatous reactions, from 166 published articles166 articles
- Participants
- 261 patients
- Comparison
- Anti-PD1/anti-PDL1 monotherapy vs combination ICI
- Outcome
- Characteristics of GRs in patients receiving ICI
Main finding
As reported in the abstract
- Mean age at GR onset, years (SD 13.0)
- 59.3
- Melanoma
- 57%
- Lung cancer
- 21%
- Lymph node involvement
- 52%
- Skin involvement
- 35%
- Nonnecrotizing granulomas
- 64%
- Necrotizing granulomas
- 15%
- Treated with systemic corticosteroids (CS)
- 45%
- Required a CS-sparing agent
- 11%
- Median follow-up, months (IQR 4.0-22.2)
- 10.1
- Granulomatous reactions (GRs) resolved by last follow-up
- 64%
Further findings
Anti-PD1/anti-PDL1 monotherapy vs combination ICI
- Monotherapy patients were older and had a longer time to GR onset
- Monotherapy patients were less likely to be treated with CS for GRs
Necrotizing GRs in patients with melanoma
- More common with combination ICI
Necrotizing vs nonnecrotizing GRs by organ
- Lung and lymph node GRs more likely nonnecrotizing; liver GRs more commonly necrotizing
Original publication
Necrotizing and Nonnecrotizing Granulomatous Reactions in Patients With Cancer Treated With Immune Checkpoint Inhibitors: A Systematic Literature Review. J Rheumatol. Published 15 July 2025. doi:10.
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