Development of tuberculosis in cancer patients receiving immune checkpoint inhibitors. (January 2020)

• Record Type: Journal Article
• Authors: Im, Yunjoo; Lee, Jeeyun; Kim, Seok Jin; Koh, Won-Jung; Jhun, Byung Woo; Lee, Se-Hoon
• Is Part Of: Respiratory medicine. Volume 161(2020)
• Publication Date: 2020-01
• Subjects: Tuberculosis -- Immune checkpoint inhibitor -- Lung cancer -- Melanoma -- Lymphoma; CI confidence interval -- DRESS drug reaction with eosinophilia and systemic symptoms -- ICI immune checkpoint inhibitors -- IQR interquartile range -- LTBI latent tuberculosis infection -- PD-1 programmed death-1 -- TB tuberculosis -- TNF tumor necrosis factor; Chest -- Diseases -- Periodicals; Chest -- Diseases -- Great Britain -- Periodicals; Respiratory organs -- Diseases -- Periodicals; Respiratory Tract Diseases -- Periodicals; Appareil respiratoire -- Maladies -- Périodiques; Thorax -- Maladies -- Périodiques; Appareil respiratoire -- Maladies -- Traitement -- Périodiques; Electronic journals; 616.2
• DOI: 10.1016/j.rmed.2019.105853
• Languages: English
• ISSNs: 0954-6111

Abstract

Abstract: Background: Limited data exist on the development of tuberculosis (TB) in cancer patients receiving immune checkpoint inhibitors (ICIs). Method: s : We evaluated the development of TB in 1144 solid-cancer patients who started ICIs (pembrolizumab, nivolumab, or atezolizumab) between July 2014 and December 2018. Results: A total of 1144 cancer patients were treated with ICIs. The median age of the patients at the start of ICI treatment was 62 years (interquartile range [IQR]; 53–69 years). Lung cancer (n = 796, 69.6%) was the most common cancer followed by melanoma (n = 115, 10.1%), and lymphoma (n = 85, 7.4%). Pembrolizumab (n = 612, 53.5%) was the most common treatment, followed by nivolumab (n = 474, 41.4%) and atezolizumab (n = 58, 5.1%). The median treatment duration with ICIs was 42 days (IQR; 18–154 days), and the median follow-up duration after initiating ICIs was 187 days (IQR; 70–342 days). Overall, three patients developed TB, two of whom received nivolumab and one who received pembrolizumab. Conclusions: Our data showed that TB can develop in cancer patients receiving ICIs. However, due to the small number of study population, it is insufficient to draw accurate conclusions about the role of ICIs in the development of TB. Moreover, it is unclear whether the incidence of TB would be comparable with the incidence of TB in elderly cancer patients. Further studies are needed to evaluate whether diagnosis and treatment of latent TB infections before starting ICIs could be helpful in preventing the development of TB in these patients. Highlights: Limited data exist on the development of tuberculosis in patients receiving immune checkpoint inhibitors. We investigated the occurrence of TB after starting ICIs in a cancer-patient cohort. The incidence rate of TB was much higher than that of the overall South Korean population in 2018. Our data showed that TB can develop in cancer patients receiving ICIs.