Jacob Zaemes1, Chul Kim2. 1. Department of Medicine, MedStar Georgetown University Hospital, Washington, DC, USA. 2. Department of Medicine, MedStar Georgetown University Hospital, Washington, DC, USA; Lombardi Comprehensive Cancer Center, MedStar Georgetown University Hospital, Washington, DC, USA. Electronic address: chul.kim@gunet.georgetown.edu.
Abstract
BACKGROUND: An amassing body of evidence exists to support an association between the use of immune checkpoint inhibitors (ICIs) and the development of tuberculosis (TB). METHODS: We performed a systematic review of the literature to assess the nature of this relationship using PubMed, EMBASE and meeting proceedings. RESULTS: We have identified 16 patients who developed active TB during immunotherapy. Median age was 61 (range: 49-87). Twelve (75%) were male and 4 (25%) were female. Lung cancer was the most common type of cancer (n = 8), followed by melanoma (n = 3) and head and neck cancer (n = 3). Median time to TB reactivation after initiation of ICI therapy was 6.3 months (range: 1-24 months). Two (13%) patients died of complications of TB (spinal cord compression, GI perforation). TB reactivation in organs (pericardium, bone, liver, and GI track; one each) other than the lungs has been documented. We did not find any cases of TB reactivation that occurred during anti-CTLA-4 therapy. CONCLUSION: Findings from our systematic review indicate that PD-(L)1 inhibitors are linked to TB reactivation. TB activation can occur in various organs and TB-related fatalities have been reported. TB screening before starting immunotherapy should be considered in high-risk patient populations. Further research, including prospective studies with patients whose baseline TB status is known, is necessary to better understand the incidence of TB reactivation during ICI therapy and how best to manage TB that develops during immunotherapy.
BACKGROUND: An amassing body of evidence exists to support an association between the use of immune checkpoint inhibitors (ICIs) and the development of tuberculosis (TB). METHODS: We performed a systematic review of the literature to assess the nature of this relationship using PubMed, EMBASE and meeting proceedings. RESULTS: We have identified 16 patients who developed active TB during immunotherapy. Median age was 61 (range: 49-87). Twelve (75%) were male and 4 (25%) were female. Lung cancer was the most common type of cancer (n = 8), followed by melanoma (n = 3) and head and neck cancer (n = 3). Median time to TB reactivation after initiation of ICI therapy was 6.3 months (range: 1-24 months). Two (13%) patientsdied of complications of TB (spinal cord compression, GI perforation). TB reactivation in organs (pericardium, bone, liver, and GI track; one each) other than the lungs has been documented. We did not find any cases of TB reactivation that occurred during anti-CTLA-4 therapy. CONCLUSION: Findings from our systematic review indicate that PD-(L)1 inhibitors are linked to TB reactivation. TB activation can occur in various organs and TB-related fatalities have been reported. TB screening before starting immunotherapy should be considered in high-risk patient populations. Further research, including prospective studies with patients whose baseline TB status is known, is necessary to better understand the incidence of TB reactivation during ICI therapy and how best to manage TB that develops during immunotherapy.
Authors: Maria Gonzalez-Cao; Teresa Puertolas; Mar Riveiro; Eva Muñoz-Couselo; Carolina Ortiz; Roger Paredes; Daniel Podzamczer; Jose Luis Manzano; Jose Molto; Boris Revollo; Cristina Carrera; Lourdes Mateu; Sara Fancelli; Enrique Espinosa; Bonaventura Clotet; Javier Martinez-Picado; Pablo Cerezuela; Ainara Soria; Ivan Marquez; Mario Mandala; Alfonso Berrocal Journal: J Immunother Cancer Date: 2021-03 Impact factor: 13.751
Authors: Kartik Anand; Geetanjali Sahu; Ethan Burns; Allyne Ensor; Joe Ensor; Sai Ravi Pingali; Vivek Subbiah; Swaminathan P Iyer Journal: ESMO Open Date: 2020-08