Development of tuberculosis in cancer patients receiving immune checkpoint inhibitors

Im, Yunjoo; Lee, Jeeyun; Kim, Seok Jin; Koh, Won‐Jung; Jhun, Byung Woo; Lee, Se‐Hoon

doi:10.1016/j.rmed.2019.105853

Cited by 26 publications

(22 citation statements)

References 20 publications

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“…In our observation with small sample size, SSG formation was associated with the favorable clinical efficacy of ICIs, although a statistical significance was not reached. In addition to the colon tissue, granuloma formation, including sarcoidosis or exacerbating tuberculosis, has been reported [75,76]. We also found a patient with a granuloma formation in the kidney whose renal tumor completely ceased after combination ipilimumab and nivolumab therapy (Figure 3(B); unpublished).…”

Section: Correlation Between Irae Expression and The Therapeutic Effectsupporting

confidence: 61%

Immunopathological basis of immune-related adverse events induced by immune checkpoint blockade therapy

Kubo

Hirohashi

Tsukahara

et al. 2021

Immunological Medicine

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Section: Correlation Between Irae Expression and The Therapeutic Effectsupporting

confidence: 61%

Immunopathological basis of immune-related adverse events induced by immune checkpoint blockade therapy

Kubo

Hirohashi

Tsukahara

et al. 2021

Immunological Medicine

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“…63 Also, a single-centre cohort in South Korea identified three cases of Mtb and calculated an incidence rate of 394.4 per 100 000 person years, higher than the rate in the South Korean population in 2018 and previous studies that included patients with lung cancer. 64 Finally, a single-centre cohort in Singapore showed that 4/191 (2.09%) of patients developed Mtb reactivation following PD-1/PD-L1 blockade. 65 AMI has also (online supplemental file 1) been associated with immunotherapy.…”

Section: State Of the Art Reviewmentioning

confidence: 99%

Infections due to dysregulated immunity: an emerging complication of cancer immunotherapy

Morelli

Fujita

Redelman-Sidi

et al. 2021

Thorax

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Immune checkpoint inhibitors (ICIs) have revolutionised cancer treatment. However, immune-related adverse events (irAEs) are a common side effect which can mimic infection. Additionally, treatment of irAEs with corticosteroids and other immunosuppressant agents can lead to opportunistic infection, which we have classed as immunotherapy infections due to immunosuppression. However, emerging reports demonstrate that some infections can be precipitated by ICIs in the absence of immunosuppressive treatment, in contrast to the majority of reported cases. These infections are characterised by a dysregulated inflammatory immune response, and so we propose they are described as immunotherapy infections due to dysregulated immunity. This review summarises the rapidly emerging evidence of these phenomena and proposes a new framework for considering infection in the context of cancer immunotherapy.

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“…Pembrolizumab ( n = 612, 53.5%), nivolumab ( n = 474, 41.4%), and atezolizumab ( n = 58, 5.1%) were the most frequent therapies. In this cohort, three patients with advanced lung cancer developed pulmonary TB, and the overall incidence rate of TB was 394.4 cases [95% confidence interval (CI) 100.3–1,073.4] per 100,000 person-years [ 17 ]. Despite these results, the retrospective design and the small number of patients are insufficient to draw precise conclusions.…”

Section: Discussionmentioning

confidence: 99%

Ganglionar tuberculosis infection evolving to hemophagocytic lymphohistiocytosis after anti-programmed cell death 1 treatment for high-risk melanoma: a case report

et al. 2021

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Background Hemophagocytic lymphohistiocytosis is a rare, potentially fatal syndrome of immune hyperactivation. Here we describe a ganglionar tuberculosis evolving to hemophagocytic lymphohistiocytosis following adjuvant immunotherapy in a melanoma patient. Case presentation A 76-year-old Caucasian male with melanoma started with fever, diffuse petechiae, splenomegaly, anemia, thrombocytopenia, hypofibrinogenemia, and hyperferritinemia 2 months following completion of adjuvant treatment with nivolumab. Positron emission tomography scan showed significant hypermetabolism in cervical, supraclavicular, mediastinal, and abdominal lymph nodes. Bone marrow aspiration demonstrated no alterations, except for a hypercellular pattern. Dexamethasone and intravenous immunoglobulin were started owing to suspicion of hemophagocytic lymphohistiocytosis. Core biopsy of the infracarinal lymph node revealed a chronic granulomatous inflammation and caseous necrosis, with positivity for Mycobacterium tuberculosis by polymerase chain reaction, and treatment for ganglionar tuberculosis was started. Conclusion This case highlights the challenges involving programmed cell death 1 blockade in high-risk melanoma, in which infections, lymphoproliferative disorders, and sarcoidosis can mimic disease progression and trigger immune-related adverse events.

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Development of tuberculosis in cancer patients receiving immune checkpoint inhibitors

Cited by 26 publications

References 20 publications

Immunopathological basis of immune-related adverse events induced by immune checkpoint blockade therapy

Immunopathological basis of immune-related adverse events induced by immune checkpoint blockade therapy

Infections due to dysregulated immunity: an emerging complication of cancer immunotherapy

Ganglionar tuberculosis infection evolving to hemophagocytic lymphohistiocytosis after anti-programmed cell death 1 treatment for high-risk melanoma: a case report

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