Table 1 Published cases of MTB reactivation in cancer patients treated with immunotherapy
First author, year | Age/sex (Origin) | Cancer type | ICB | Line (Duration) | Additional Immunosuppression (dose, duration) | Symptoms | MTB confirmation | Management | Outcome |
|---|---|---|---|---|---|---|---|---|---|
Lee J, 2016 [41] | 87/Male (Asian) | HL | Pembrolizumab | 2nd (5 cycles) | None | Fever, fatigue and weight loss | Sputum culture (+) | Anti-MTB: 3-drug regimen ICB: Temporary Discontinuation | Complete remission of pulmonary MTB |
Fujita K, 2016 [42] | 72/Male (Asian) | Metastatic NSCLC | Nivolumab | 2nd (8 cycles) | None | N/A | BAL culture (+), PCR(+) | Anti-MTB: N/A ICB: N/A | N/A |
Chu YC, 2017 [43] | 59/Male (Asian) | Metastatic NSCLC | Nivolumab | 2nd (3 cycles) | Prednisolone (1 mg/kg, for 1 month) | Tamponade | Histology and Pericardial fluid culture (+) | Anti-MTB: N/A ICB: Maintenance | Complete regression of pericarditis |
He W, 2018 [44] | 65/Female (Asian) | Metastatic Melanoma | Pembrolizumab | 1st (10 cycles) | None | Bloody sputum | AFB(+), PCR(+), Sputum Culture (+) | Anti-MTB: 4-drug regimen ICB: | Stop anti-MTB due to toxicity, second anti-MTB regimen Completion of 14 cycles of ICB |
Jensen KH, 2018 [45] | 56/Male (Caucasian) | Advanced NSCLC | Nivolumab | 3rd (12 cycles) | None | Asymptomatic | AFB(+), PCR(+) | Anti-MTB medication, ICB: Discontinuation | N/A |
Picchi H, 2018 [46] | 50/Male (Caucasian) | Metastatic Melanoma | Pembrolizumab | 1st (4 cycles) | None | Asymptomatic pleurisy | Histology and TST (+) | Anti-MTB: 4-drug regimen ICB: Maintenance | Complete regression of pleural effusion |
64/Male (Caucasian) | Metastatic NSCLC | Nivolumab | 2nd (2 cycles) | None | Spinal cord compression | Histology, Bone culture (+), PCR (+) | Anti-MTB: ICB: Discontinuation | DOD: Rapidly after 2nd operation for spinal cord compression | |
Elkington PT, 2018 [47] | 62/Female (Caucasian) | Metastatic Melanoma | Pembrolizumab | 2nd (N/A) | None | Abnormalities in LFTs and an imaging lung lesion | Histology, BAL culture (+) | Anti-MTB: 4-drug regimen ICB: Temporary Discontinuation | Clinical improvement, normalization of LFTs and regression of the lung lesion |
Tsai CC, 2019 [48] | 49/Male (Asian) | Metastatic HNSCC | Nivolumab | 2nd (6 cycles) | None | Fever and cough | AFB(+), PCR(+), Sputum Culture (+) | Anti-MTB medication, ICB: Discontinuation | DOD: 5 months after MTB diagnosis with bacterial pneumonia and ARF |
Takata S, 2019 [49] | 75/Male (Asian) | Metastatic NSCLC | Nivolumab | 4th (15 cycles) | None | Fever, cough, and purulent sputum | AFB(+), Sputum Culture (+), PCR(+) | Anti-MTB: 4-drug regimen for 2 months, and 2-drug combination for 7 months ICB: Temporary Discontinuation | Nivolumab restarted after anti-MTB induction, reaching to PR after 46 cycles without relapse of MTB. |
Barber DL, 2019 [37] | 59/Male (Caucasian) | Metastatic HNSCC | Nivolumab | 1st (3 cycles) | None | Asymptomatic | AFB(+), PCR(+), Sputum Culture (+) | Anti-MTB: 3-drug regimen ICB: Discontinuation | Patient worsened (supplemental oxygen, persistently febrile, and hypotensive) DOD: 2 months after initiation of ICB |
83/Male (Caucasian) | Metastatic MCC | Pembrolizumab | 1st (12 cycles) | None | Asymptomatic | AFB (+) | Anti-MTB: 4-drug regimen ICB: Temporary Discontinuation | Anti-MTB: changed to 2-drug regimen due to elevated liver enzymes and completed in 9 months. MCC progressed and pembrolizumab restarted with resultant tumor reduction. | |
Current study, 2019 | |||||||||
Patient#1 | 76/Female (Caucasian) | Advanced Melanoma | Nivolumab+/−Ipilimumab | Adjuvan (8 cycles) | Methylprednisolone (32 mg daily for ~ 3 months) and infliximab (5 mg/kg for 3 doses) | Fever and cough | BAL culture (+), PCR(+) | Anti-MTB: 3-drug regimen ICB: Discontinuation | DOD: 3 days after anti-MTB initiation with ARF |
Patient#2 | 85/Male (Caucasian) | Metastatic Melanoma | Atezolizumab+cobimetinib | 1st (9 cycles) | None | Fever and cough | Sputum Culture (+) | Anti-MTB: 4-drug regimen ICB: Maintenance | Complete remission of pulmonary MTB, SD of melanoma and continuation of ICB |