Treatment with combined BRAF and MEK inhibition is widely accepted as a first-line treatment option for patients with advanced BRAF V600E mutant melanoma. It is generally well-tolerated and has limited side-effects. However, we report a case of a sarcoid-like syndrome induced by treatment with dabrafenib/trametinib (D/T) in a patient with stage IV-M1d melanoma. Sarcoid-like syndrome is a known side-effect of immune checkpoint-inhibition therapy but has only rarely been described in BRAF/MEK inhibition. However, recognizing this side-effect is important because of potential misinterpretation as progressive disease and influence on treatment. We describe a 48-year-old female patient who initially presented with solitary brain metastasis and diffuse lung lesions. She was treated with D/T to which she had an initial response in all lesions. One year later, new hilar and mediastinal lymphadenopathies were detected. Imaging was suggestive of the sarcoid-like syndrome. An endoscopic biopsy of the enlarged lymph node showed no melanoma cells. Treatment was continued. Three months later, the patient experienced a drop in hemoglobin, which prompted further investigations into possible occult intestinal metastasis. Video capsule examination revealed a metastatic lesion in the small intestine. A treatment switch to the combination of checkpoint inhibitors nivolumab and ipilimumab successfully treated both lung and small intestine lesions. After the third dose of this combination therapy, she developed an immune-related pneumonitis. Treatment with corticosteroids resolved the pneumonitis and decreased metabolism in the sarcoid-like syndrome. The treatment was not restarted afterward. She remains free of the disease up to today, 2.5 years after diagnosis.

中文翻译：

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BRAF V600E 突变的转移性黑色素瘤患者在接受 BRAF/MEK 靶向治疗期间出现结节样反应。

联合 BRAF 和 MEK 抑制剂治疗被广泛接受为晚期 BRAF V600E 突变黑色素瘤患者的一线治疗选择。它通常具有良好的耐受性并且副作用有限。然而，我们报告了一例在 IV-M1d 期黑色素瘤患者中使用达拉非尼/曲美替尼 (D/T) 治疗诱发的类肉瘤综合征病例。结节样综合征是免疫检查点抑制治疗的已知副作用，但在 BRAF/MEK 抑制中很少被描述。然而，认识到这种副作用很重要，因为潜在的误解为疾病进展和对治疗的影响。我们描述了一名 48 岁的女性患者，她最初表现为孤立性脑转移和弥漫性肺部病变。她接受了 D/T 治疗，她对所有病变都有初步反应。一年后，检测到新的肺门和纵隔淋巴结病。影像学提示肉瘤样综合征。肿大淋巴结的内窥镜活检显示没有黑色素瘤细胞。继续治疗。三个月后，患者的血红蛋白下降，这促使进一步调查可能的隐匿性肠转移。视频胶囊检查显示小肠有转移性病变。治疗转换为检查点抑制剂纳武单抗和伊匹单抗的组合成功治疗了肺和小肠病变。在第三剂联合治疗后，她患上了免疫相关性肺炎。皮质类固醇治疗解决了肺炎并降低了类肉瘤综合征的代谢。之后没有重新开始治疗。