Activated pulmonary tuberculosis in a patient with melanoma during PD-1 inhibition: a case report

Abstract

BackgroundPD-1 checkpoint inhibitors have shown a robust tumor response in the treatment of various cancers. Pembrolizumab is an anti-PD-1 checkpoint antibody approved for the treatment of unresectable or metastatic melanoma in more than 40 countries. Although autoimmune pneumonitis is considered a common immune-related adverse event of PD-1 inhibitors, only limited studies have assessed the development of opportunistic infections such as pulmonary tuberculosis (TB).Case presentationA patient with metastatic melanoma whose pulmonary TB was activated after administration of pembrolizumab for melanoma is reported. Anti-TB drugs were administered, followed by pembrolizumab (2 mg/kg, repeated every 28 days), which successfully cured the TB and achieved complete response for melanoma.ConclusionActivated pulmonary TB was observed during the administration of pembrolizumab. It was safe and effective in the current patient to combine anti-TB drugs and PD-1 inhibitors. More importantly, screening pulmonary TB before administration of PD-1 inhibitors is recommended.

PD‐1 inhibitors for non‐small cell lung cancer patients with special issues: Real‐world evidence

“…To our knowledge, there have only been seven reports about acute Tbc infections or reactivations in patients receiving ICI treatment . In this study, Three patients were newly diagnosed with pulmonary Tbc during their anti‐PD‐1 treatment.…”

“…Tuberculosis is still a burdensome disease worldwide. With regard to pulmonary tuberculosis, only seven patients treated with ICIs have been described in previous reports, and the association of ICIs with Tbc reactivation remains ambiguous …”

“…With regard to pulmonary tuberculosis, only seven patients treated with ICIs have been described in previous reports, and the association of ICIs with Tbc reactivation remains ambiguous. [11][12][13][14][15][16][17] At present, over 10 million people in the United States have an autoimmune disease. 18 According to a Medicare database analysis, approximately 13.5-24.6% of lung cancer patients in the United States have an autoimmune disease.…”

Recommendation for the diagnosis and management of immune checkpoint inhibitor related infections

“…Of note, among patients without irAEs or additional immunosuppressive therapy, there exists a potential risk of reactivation of chronic/latent infections. Seven cases have been recently reported that describe reactivation of latent tuberculosis infection (LTBI), most occurring within three months after treatment with PD‐1/PD‐L1 inhibitors . The possible mechanism may involve a boost of T helper cell (TH)1 function, resembling the immune reconstitution inflammatory syndrome (IRIS) observed in HIV patients at the beginning of antiretroviral therapy.…”

“…Seven cases have been recently reported that describe reactivation of latent tuberculosis infection (LTBI), most occurring within three months after treatment with PD-1/PD-L1 inhibitors. 4,[17][18][19] The possible mechanism may involve a boost of T helper cell (TH)1 function, 17 resembling the immune reconstitution inflammatory syndrome (IRIS) observed in HIV patients at the beginning of antiretroviral therapy. According to REISAMIC (a French, multicenter, prospective registry), the relative incidence of tuberculosis (TB) was approximately one in 1000 among cancer patients receiving PD1/PD-L1 inhibitors.…”