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Table 1 Published cases of MTB reactivation in cancer patients treated with immunotherapy

From: Reactivation of tuberculosis in cancer patients following administration of immune checkpoint inhibitors: current evidence and clinical practice recommendations

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
  1. Abbreviation: ICB immune checkpoint inhibitor, HL Hodgkin Lymphoma, HNSCC head and neck squamous cell carcinoma, NSCLC non-small-cell lung cancer, AFB acid-fast bacilli, BAL bronchoalveolar lavage, MTB mycobacterial tuberculosis, MCC Merkel cell carcinoma, SD stable disease, PR partial response, ARF acute respiratory failure, LFT liver function tests, DOD date of death